Provider Demographics
NPI:1619954658
Name:DIAMOND, DAVID A (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:DIAMOND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:300 LONGWOOD AVE
Mailing Address - Street 2:CHILDRENS UROLOGICAL FOUNDATION
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5724
Mailing Address - Country:US
Mailing Address - Phone:617-730-0474
Mailing Address - Fax:617-355-8338
Practice Address - Street 1:300 LONGWOOD AVE
Practice Address - Street 2:CHILDRENS UROLOGICAL FOUNDATION
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5724
Practice Address - Country:US
Practice Address - Phone:617-355-8338
Practice Address - Fax:617-730-0474
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2023-07-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY308942363AM0700X
MA52996208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
3072791OtherWCT
732016OtherTUFTS
1900273OtherUNI4
AA8296OtherHPHC
1900273OtherUHP
4321198002OtherCIG2
93183OtherFCHP
11273OtherHNE
1900273OtherMETRA
30007318OtherWNH
P2781842OtherOXFORD
000000009230OtherBMC
1900273OtherUNI7
991939OtherNETHE
Z11048OtherHEALT
1900273OtherUNI1
0000871OtherNHP
MA6192653Medicaid
P2781842OtherOXFORD