Provider Demographics
NPI:1265455067
Name:KHAN, SHAGUFTA A (MD)
Entity Type:Individual
Prefix:
First Name:SHAGUFTA
Middle Name:A
Last Name:KHAN
Suffix:
Gender:F
Credentials:MD
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 636256 CENTRAL CREDENTIALING
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6256
Mailing Address - Country:US
Mailing Address - Phone:513-585-5507
Mailing Address - Fax:513-585-5511
Practice Address - Street 1:234 GOODMAN ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2364
Practice Address - Country:US
Practice Address - Phone:513-584-7284
Practice Address - Fax:513-584-3807
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35086351207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH07-05612OtherUNITED HEALTHCARE
OH7749753OtherAETNA
IN200532340Medicaid
KY64103138Medicaid
OHP00244523OtherRAILROAD MEDICARE
MI4860790Medicaid
OH000000372761OtherANTHEM
OH2612686Medicaid
KY64103138Medicaid
OHKH4165531Medicare PIN