Provider Demographics
NPI:1043578990
Name:DIAZ-COLLADO, PABLO (MD)
Entity Type:Individual
Prefix:DR
First Name:PABLO
Middle Name:
Last Name:DIAZ-COLLADO
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 1:125 PARKER HILL AVENUE
Mailing Address - Street 2:CONVERSE 4, SUITE 1
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02120-2847
Mailing Address - Country:US
Mailing Address - Phone:617-754-5471
Mailing Address - Fax:617-754-5740
Practice Address - Street 1:125 PARKER HILL AVENUE
Practice Address - Street 2:CONVERSE 4, SUITE 1
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02120-2847
Practice Address - Country:US
Practice Address - Phone:617-754-5471
Practice Address - Fax:617-754-5740
Is Sole Proprietor?:No
Enumeration Date:2012-04-29
Last Update Date:2018-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA275016207XS0117X
MO2017014185207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAMD1145982AOtherMASSACHUSETTS CONTROLLED SUBSTANCES REGISTRATION
MA275016OtherMASSACHUSETTS MEDICAL LICENSE NUMBER