Provider Demographics
NPI:1477549871
Name:KHAN, SHAUKAT ALI (MD)
Entity Type:Individual
Prefix:MR
First Name:SHAUKAT
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 1:2905 CROUSE LN
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-8833
Mailing Address - Country:US
Mailing Address - Phone:336-538-2494
Mailing Address - Fax:336-538-2497
Practice Address - Street 1:2905 CROUSE LN
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-8833
Practice Address - Country:US
Practice Address - Phone:336-538-2494
Practice Address - Fax:336-538-2497
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9700308207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891028KMedicaid
NC891028KMedicaid
F75185Medicare UPIN