Provider Demographics
NPI:1366401036
Name:SHAH KHAN, SARDAR MAHMOOD (MD, MRCP)
Entity type:Individual
Prefix:DR
First Name:SARDAR
Middle Name:MAHMOOD
Last Name:SHAH KHAN
Suffix:
Gender:M
Credentials:MD, MRCP
Other - Prefix:DR
Other - First Name:S.
Other - Middle Name:M
Other - Last Name:SHAH-KHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, MRCP
Mailing Address - Street 1:303 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-3844
Mailing Address - Country:US
Mailing Address - Phone:828-433-6144
Mailing Address - Fax:
Practice Address - Street 1:303 S COLLEGE ST
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-3844
Practice Address - Country:US
Practice Address - Phone:828-433-6144
Practice Address - Fax:828-437-4304
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16726207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8975397Medicaid
NCD20652Medicare UPIN
NC201325Medicare ID - Type Unspecified