Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | 275016 | MA |
NPI | 1043578990 |
---|---|
Provider Name | Dr. Pablo Diaz-Collado |
First Address | Boston, MA 02120-2847 |
Second Address | Boston, MA 02120-2847 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2012 |
Last Update Date | 22/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
275016 | MASSACHUSETTS MEDICAL LICENSE NUMBER (01) | MA |
MD1145982A | MASSACHUSETTS CONTROLLED SUBSTANCES REGISTRATION (01) | MA |