Provider Demographics
NPI:1558387472
Name:SALOOM, CHARLENE RAE (DO)
Entity Type:Individual
Prefix:DR
First Name:CHARLENE
Middle Name:RAE
Last Name:SALOOM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:CHARLENE
Other - Middle Name:SALOOM
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1070 OLD NATIONAL PIKE RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICKTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15333-2114
Mailing Address - Country:US
Mailing Address - Phone:724-632-6801
Mailing Address - Fax:724-632-6312
Practice Address - Street 1:208 S. ARCH STREET
Practice Address - Street 2:
Practice Address - City:CONNELLSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15425-3519
Practice Address - Country:US
Practice Address - Phone:724-626-2630
Practice Address - Fax:724-626-2655
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS013236207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007288440037Medicaid
PA101706672Medicaid
PA1007288440037Medicaid
PA101706672Medicaid