Healthcare Provider Details

I. General information

NPI: 1346342458
Provider Name (Legal Business Name): SHAHNOOR ALI KHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 STREET OF DREAMS
MARTINSBURG WV
25403-1134
US

IV. Provider business mailing address

PO BOX 4056
MARTINSBURG WV
25402-4056
US

V. Phone/Fax

Practice location:
  • Phone: 304-264-1442
  • Fax: 304-264-4317
Mailing address:
  • Phone: 703-400-3433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number20620
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: