Provider Demographics
NPI:1033180211
Name:SHORAGO, GEORGE WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:WILLIAM
Last Name:SHORAGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:50 S SAN MATEO DR
Mailing Address - Street 2:SUITE 320
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-3857
Mailing Address - Country:US
Mailing Address - Phone:650-340-7200
Mailing Address - Fax:650-340-9514
Practice Address - Street 1:50 S SAN MATEO DR
Practice Address - Street 2:SUITE 320
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-3857
Practice Address - Country:US
Practice Address - Phone:650-340-7200
Practice Address - Fax:650-340-9514
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG10966207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
94-2824952Medicare ID - Type UnspecifiedFEDERAL TAX ID NUMBER
A38146Medicare UPIN