Provider Demographics
NPI:1356350995
Name:DIAMOND, PAMELA F (MD)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:F
Last Name:DIAMOND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 MILK ST
Mailing Address - Street 2:PROVIDER ENROLLMENT 9TH FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-4806
Mailing Address - Country:US
Mailing Address - Phone:617-421-2508
Mailing Address - Fax:617-421-3487
Practice Address - Street 1:1611 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-4302
Practice Address - Country:US
Practice Address - Phone:617-661-5525
Practice Address - Fax:617-661-5202
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA72655207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA072655OtherTUFTS HEALTH PLAN
MA5112772-003OtherCIGNA
MA0014865OtherNEIGHBORHOOD HEALTH PLAN
MAJ09809OtherBLUE CROSS
MA3062104Medicaid
MAJ188OtherHARVARD PILGRIM
MAE50264Medicare UPIN
MA3062104Medicaid