Provider Demographics
NPI:1154367290
Name:KHAN, SHAZIA (MD)
Entity type:Individual
Prefix:
First Name:SHAZIA
Middle Name:
Last Name:KHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHAZIA
Other - Middle Name:
Other - Last Name:SALAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8197 LAWRENCE RD
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069
Mailing Address - Country:US
Mailing Address - Phone:513-779-5215
Mailing Address - Fax:
Practice Address - Street 1:930 9TH AVE
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45044
Practice Address - Country:US
Practice Address - Phone:513-425-8305
Practice Address - Fax:513-425-1810
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35085441207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2602615Medicaid
A298815OtherAMERIGROUP
4167332Medicare ID - Type Unspecified