Provider Demographics
NPI:1952530677
Name:QUDDUS, FAHD (MB, BS)
Entity Type:Individual
Prefix:
First Name:FAHD
Middle Name:
Last Name:QUDDUS
Suffix:
Gender:M
Credentials:MB, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 25039
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29616-0039
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:317 SAINT FRANCIS DR
Practice Address - Street 2:SUITE 340
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-3965
Practice Address - Country:US
Practice Address - Phone:864-546-3699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-02
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5899207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology