Healthcare Provider Details

I. General information

NPI: 1174029417
Provider Name (Legal Business Name): HAROLD VIVIANO CEDENO ABREU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2018
Last Update Date: 06/14/2024
Certification Date: 06/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 LEE ST BOX 800546
CHARLOTTESVILLE VA
22908-0816
US

IV. Provider business mailing address

1215 LEE ST BOX 800546
CHARLOTTESVILLE VA
22908-0816
US

V. Phone/Fax

Practice location:
  • Phone: 434-924-5219
  • Fax: 434-244-7509
Mailing address:
  • Phone: 434-924-9610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number69051
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number0116038898
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: