Provider Demographics
NPI:1316050289
Name:CHOUGH, EDWARD K (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:K
Last Name:CHOUGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3443 VILLA LN
Mailing Address - Street 2:SUITE 3
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-6417
Mailing Address - Country:US
Mailing Address - Phone:707-226-2031
Mailing Address - Fax:707-252-1087
Practice Address - Street 1:3443 VILLA LN
Practice Address - Street 2:SUITE 3
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-6417
Practice Address - Country:US
Practice Address - Phone:707-226-2031
Practice Address - Fax:707-252-1087
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC76787208600000X
CAG76787207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G767870Medicaid
CA00G767870OtherBLUE SHIELD
CA00G767870Medicare PIN
CA00G767870Medicaid