Provider Demographics
NPI:1396994109
Name:DIAS, CELSO E (MD)
Entity type:Individual
Prefix:DR
First Name:CELSO
Middle Name:E
Last Name:DIAS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:30 HAGEN DR SUITE 120
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625
Mailing Address - Country:US
Mailing Address - Phone:585-922-5300
Mailing Address - Fax:585-922-0450
Practice Address - Street 1:30 HAGEN DR SUITE 120
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14625
Practice Address - Country:US
Practice Address - Phone:585-922-5300
Practice Address - Fax:585-922-0450
Is Sole Proprietor?:No
Enumeration Date:2008-09-17
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MEMD18370208600000X, 2086S0129X
MA2605112086S0129X
NY2719492086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1396994109Medicaid
ME001702001Medicare PIN