Provider Demographics
NPI:1528011863
Name:ROSADO, VICTOR MANUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:MANUEL
Last Name:ROSADO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:650 STATESVILLE BLVD
Mailing Address - Street 2:STE 1
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144-2216
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:STE 1
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-2216
Practice Address - Country:US
Practice Address - Phone:704-636-9912
Practice Address - Fax:704-639-0794
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC351882084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8973062Medicaid
NCF19468Medicare UPIN
NC2168274Medicare ID - Type Unspecified