Provider Demographics
NPI:1508855958
Name:KHOKAR, SHAHID MUNIF (MD)
Entity Type:Individual
Prefix:MR
First Name:SHAHID
Middle Name:MUNIF
Last Name:KHOKAR
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 708
Mailing Address - Street 2:
Mailing Address - City:BLUEFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:24605-0708
Mailing Address - Country:US
Mailing Address - Phone:276-322-2450
Mailing Address - Fax:276-322-2621
Practice Address - Street 1:4 WESTWOOD MEDICAL PARK
Practice Address - Street 2:
Practice Address - City:BLUEFIELD
Practice Address - State:VA
Practice Address - Zip Code:24605-2000
Practice Address - Country:US
Practice Address - Phone:276-322-2450
Practice Address - Fax:276-322-2621
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101230757208000000X
WV20449208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006738711Medicaid
WV2002345000Medicaid
WV2002345000Medicaid
VA006738711Medicaid