MEDICARE: DR. SHAHNAWAZ AHMED KHAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator	22462	OK
2	173000000X	Legal Medicine	22462	OK
3	207Q00000X	Family Medicine Physician	D0062190	MD
4	207Q00000X	Family Medicine Physician	C1-0009568	DE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730282666
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHAHNAWAZ AHMED KHAN MD

Provider Business Mailing Address
First Line	:	2533 AUGUSTINE HERMAN HWY
Second Line	:	SUITE A
City	:	CHESAPEAKE CITY
State	:	MD
Zip	:	21915
Country	:	US
Telephone Number	:	410-885-5018
Fax Number	:	410-885-5026

Provider Business Practice Location Address
First Line	:	2533 AUGUSTINE HERMAN HWY
Second Line	:	SUITE A
City	:	CHESAPEAKE CITY
State	:	MD
Zip	:	21915-1414
Country	:	US
Telephone Number	:	410-885-5018
Fax Number	:	410-885-5026

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	07/17/2013

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