Provider Demographics
NPI:1346342458
Name:KHAN, SHAHNOOR ALI (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAHNOOR
Middle Name:ALI
Last Name:KHAN
Suffix:
Gender:M
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 4056
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25402-4056
Mailing Address - Country:US
Mailing Address - Phone:703-400-3433
Mailing Address - Fax:
Practice Address - Street 1:51 STREET OF DREAMS
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25403-1134
Practice Address - Country:US
Practice Address - Phone:304-264-1442
Practice Address - Fax:304-264-4317
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV206202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD0064888OtherSTATE MEDICAL LICENSE
WV2000700000Medicaid
WV20620OtherSTATE MEDICAL LICENSE
VA296305OtherBC ANTHEM
VA0101235819OtherSTATE MEDICAL LICENSE
VA296305OtherBC ANTHEM