Healthcare Provider Details

I. General information

NPI: 1417930959
Provider Name (Legal Business Name): ROBERTO O SALCEDO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 10/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 N BUHL FARM DR
HERMITAGE PA
16148-1718
US

IV. Provider business mailing address

100 SHENANGO AVE
SHARON PA
16146-1503
US

V. Phone/Fax

Practice location:
  • Phone: 724-342-2789
  • Fax: 724-342-3119
Mailing address:
  • Phone: 724-704-7386
  • Fax: 724-704-7390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD056975L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: