Provider Demographics
NPI:1730282666
Name:KHAN, SHAHNAWAZ AHMED (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAHNAWAZ
Middle Name:AHMED
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 1:2533 AUGUSTINE HERMAN HWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHESAPEAKE CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21915
Mailing Address - Country:US
Mailing Address - Phone:410-885-5018
Mailing Address - Fax:410-885-5026
Practice Address - Street 1:2533 AUGUSTINE HERMAN HWY
Practice Address - Street 2:SUITE A
Practice Address - City:CHESAPEAKE CITY
Practice Address - State:MD
Practice Address - Zip Code:21915-1414
Practice Address - Country:US
Practice Address - Phone:410-885-5018
Practice Address - Fax:410-885-5026
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK22462171M00000X, 173000000X
MDD0062190207Q00000X
DEC1-0009568207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD200007490AMedicaid
OK200007490AMedicaid
I22532Medicare UPIN
OK244435001Medicare PIN
OKI22532Medicare UPIN
MD200007490AMedicaid