Provider Demographics
NPI:1114126067
Name:KHAN, SHUJAUDDIN (MD)
Entity Type:Individual
Prefix:
First Name:SHUJAUDDIN
Middle Name:
Last Name:KHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SHUJA
Other - Middle Name:U
Other - Last Name:KHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:35 E WILLIAMSBURG RD
Mailing Address - Street 2:
Mailing Address - City:SANDSTON
Mailing Address - State:VA
Mailing Address - Zip Code:23150-2011
Mailing Address - Country:US
Mailing Address - Phone:804-737-7804
Mailing Address - Fax:
Practice Address - Street 1:35 E WILLIAMSBURG RD
Practice Address - Street 2:
Practice Address - City:SANDSTON
Practice Address - State:VA
Practice Address - Zip Code:23150-2011
Practice Address - Country:US
Practice Address - Phone:804-737-7804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101053528208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA454249OtherANTHEM BCBS
VA005877814Medicaid
VA705067OtherAETNA
VA705067OtherAETNA
VA005877814Medicaid