Provider Demographics
NPI:1356329437
Name:SALCEDO, HERNANDO (MD)
Entity Type:Individual
Prefix:
First Name:HERNANDO
Middle Name:
Last Name:SALCEDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 40908
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28309-0908
Mailing Address - Country:US
Mailing Address - Phone:910-615-3220
Mailing Address - Fax:910-486-2170
Practice Address - Street 1:2301 ROBESON ST
Practice Address - Street 2:SUITE 203
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5640
Practice Address - Country:US
Practice Address - Phone:910-615-3220
Practice Address - Fax:910-486-2170
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101020668208800000X
NC200700289208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC145A4OtherBCBS-NC
NC5906149Medicaid
NC5906149Medicaid
NC145A4OtherBCBS-NC