Provider Demographics
NPI:1982671129
Name:AVUNDUK, CANAN (MD PHD)
Entity Type:Individual
Prefix:
First Name:CANAN
Middle Name:
Last Name:AVUNDUK
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:536 LEBANON ST
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176
Mailing Address - Country:US
Mailing Address - Phone:781-979-0286
Mailing Address - Fax:781-979-0324
Practice Address - Street 1:536 LEBANON ST
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176
Practice Address - Country:US
Practice Address - Phone:781-979-0286
Practice Address - Fax:781-979-0324
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA46084207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6175864Medicaid
E01831Medicare UPIN
J02924Medicare ID - Type Unspecified