MEDICARE: DR. KHURRUM SHEHZAD 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	390200000X	Student in an Organized Health Care Education/Training Program	0116036750	VA
2	207Q00000X	Family Medicine Physician	MD490983	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	207Q0000X	OTHER	VA	FAMILY MEDICINE

General Provider Information

NPI Number	:	1912638198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KHURRUM SHEHZAD MD

Provider Business Mailing Address
First Line	:	2100 MACK BLVD FL 4
Second Line	:
City	:	ALLENTOWN
State	:	PA
Zip	:	18103-5622
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	292 FRANTZ RD STE 108
Second Line	:
City	:	STROUDSBURG
State	:	PA
Zip	:	18360-6205
Country	:	US
Telephone Number	:	570-426-2900
Fax Number	:

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

Provider Enumeration Date	:	06/20/2022
Last Update Date	:	09/02/2025

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