Shough, Charlene G

Shough, Charlene G is an individual health care provider with primary practice located at 751 S Bascom Ave Pediatrics Dept, San Jose CA 95128-2604. She recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pediatrics, Allopathic & Osteopathic Physicians / Developmental – Behavioral Pediatrics, Allopathic & Osteopathic Physicians / Pediatric Endocrinology. Allopathic & Osteopathic Physicians / Pediatric Endocrinology is her primary health care specialty. Shough, Charlene G can be contacted via phone (408) 885-5630.

Contact Information

Primary practice address
751 S Bascom Ave Pediatrics Dept San Jose CA 95128-2604
Phone: (408) 885-5630
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X G25692 California
Allopathic & Osteopathic Physicians / Developmental – Behavioral Pediatrics 2080P0006X G25692 California
Allopathic & Osteopathic Physicians / Pediatric Endocrinology 2080P0205X G25692 California

Profile Details

NPI number 1629173224
LBN Legal business name Shough, Charlene G
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 14th, 2006
Last updated Sep 12th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1629173224 NPPES
California MEDICAID 00G256920

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