Provider Demographics
NPI:1215498605
Name:PENA, SALVADOR ENRIQUE JR (MD PHD)
Entity type:Individual
Prefix:DR
First Name:SALVADOR
Middle Name:ENRIQUE
Last Name:PENA
Suffix:JR
Gender:M
Credentials:MD PHD
Other - Prefix:DR
Other - First Name:SALVADOR
Other - Middle Name:ENRIQUE
Other - Last Name:PENA
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:MD PHD
Mailing Address - Street 1:MEDICAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27157-0001
Mailing Address - Country:US
Mailing Address - Phone:336-716-2255
Mailing Address - Fax:336-716-3202
Practice Address - Street 1:WAKE FOREST BAPTIST HEALTH MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-0001
Practice Address - Country:US
Practice Address - Phone:336-716-6410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-27
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2023-01042207L00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology