Provider Demographics
NPI:1760658389
Name:DIAZ COTELO, DAMIAN ANTONIO (MD)
Entity Type:Individual
Prefix:DR
First Name:DAMIAN
Middle Name:ANTONIO
Last Name:DIAZ COTELO
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 1:750 BRUNSWICK AVE
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08638-4143
Mailing Address - Country:US
Mailing Address - Phone:609-394-6000
Mailing Address - Fax:
Practice Address - Street 1:11767 S DIXIE HWY
Practice Address - Street 2:423
Practice Address - City:PINECREST
Practice Address - State:FL
Practice Address - Zip Code:33156-4438
Practice Address - Country:US
Practice Address - Phone:786-417-6215
Practice Address - Fax:855-268-3561
Is Sole Proprietor?:No
Enumeration Date:2008-05-03
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 105957208M00000X, 207R00000X
NJ25MA08604200207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist