Provider Demographics
NPI:1427255009
Name:SALAMANCA, VICTOR RAUL (MD)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:RAUL
Last Name:SALAMANCA
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 1:564 1ST AVE
Mailing Address - Street 2:APT 17X
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6482
Mailing Address - Country:US
Mailing Address - Phone:319-594-6542
Mailing Address - Fax:
Practice Address - Street 1:564 1ST AVE, APT 17X
Practice Address - Street 2:
Practice Address - City:NEW YORK CITY
Practice Address - State:NY
Practice Address - Zip Code:10016-3203
Practice Address - Country:US
Practice Address - Phone:319-594-6542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-28
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR-8216208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery