Provider Demographics
NPI:1033397526
Name:VICTOR M. ROSADO MD PA
Entity Type:Organization
Organization Name:VICTOR M. ROSADO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:PROF
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:E
Authorized Official - Last Name:PEELER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-636-9912
Mailing Address - Street 1:650 STATESVILLE BLVD
Mailing Address - Street 2:STE1
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-2284
Mailing Address - Country:US
Mailing Address - Phone:704-636-9912
Mailing Address - Fax:704-639-0794
Practice Address - Street 1:650 STATESVILLE BLVD
Practice Address - Street 2:STE1
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-2284
Practice Address - Country:US
Practice Address - Phone:704-636-9912
Practice Address - Fax:704-639-0794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC35188251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8973062Medicaid
NC8973062Medicaid