Provider Demographics
NPI:1134100811
Name:SALCEDO, STEPHEN L (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:L
Last Name:SALCEDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:755 BOARDMAN CANFIELD RD
Mailing Address - Street 2:P-2
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-4300
Mailing Address - Country:US
Mailing Address - Phone:330-758-7084
Mailing Address - Fax:330-758-2099
Practice Address - Street 1:755 BOARDMAN CANFIELD RD
Practice Address - Street 2:P-2
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-4300
Practice Address - Country:US
Practice Address - Phone:330-758-7084
Practice Address - Fax:330-758-2099
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2010-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH56229207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH001716140OtherHIGHMARK
OH0713400Medicaid
OH32126OtherHEALTH AMERICA
OH341570956OtherMEDICAL MUTUAL
OH6632038OtherCIGNA
OH000000134251OtherANTHEM
OH341570956OtherACORDIA
OH341570956OtherUNITED MEDICAL RESOURCES
OH4257781OtherAETNA
OH341570956OtherUNITED HEALTHCARE
OH071340013OtherTOTAL HEALTHCARE
OH1546401OtherGATEWAY HMO
OH996010852OtherPRM
OH070002214OtherMEDICARE R.R.
OH220720OtherCOVENTRY HEALTH
OH341570956OtherDCA
OH341570956OtherUNITED MEDICAL RESOURCES
OH000000134251OtherANTHEM
OH341570956OtherMEDICAL MUTUAL