Healthcare Provider Details

I. General information

NPI: 1205366374
Provider Name (Legal Business Name): ROMULO ANDRE SALUD FAJARDO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2017
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 MAGNOLIA ST
GREENSBORO NC
27401-1309
US

IV. Provider business mailing address

600 HIGHLAND AVE
MADISON WI
53792-5103
US

V. Phone/Fax

Practice location:
  • Phone: 336-832-3200
  • Fax: 336-832-3201
Mailing address:
  • Phone: 276-971-5050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number8228520
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number2026-00202
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: