Basic Information
| Provider Information | |||||||||
| NPI: | 1356329437 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SALCEDO | ||||||||
| FirstName: | HERNANDO | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 40908 | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283090908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9106153220 | ||||||||
| FaxNumber: | 9104862170 | ||||||||
| Practice Location | |||||||||
| Address1: | 2301 ROBESON ST | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283055640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9106153220 | ||||||||
| FaxNumber: | 9104862170 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2006 | ||||||||
| LastUpdateDate: | 02/11/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 0101020668 | VA | N | Allopathic & Osteopathic Physicians | Urology | 208800000X | 200700289 | NC | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 145A4 | 01 | NC | BCBS-NC | OTHER | 5906149 | 05 | NC | MEDICAID |