Healthcare Provider Details

I. General information

NPI: 1356329437
Provider Name (Legal Business Name): HERNANDO SALCEDO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 02/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 ROBESON ST SUITE 203
FAYETTEVILLE NC
28305-5640
US

IV. Provider business mailing address

PO BOX 40908
FAYETTEVILLE NC
28309-0908
US

V. Phone/Fax

Practice location:
  • Phone: 910-615-3220
  • Fax: 910-486-2170
Mailing address:
  • Phone: 910-615-3220
  • Fax: 910-486-2170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number0101020668
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number200700289
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: