Healthcare Provider Details

I. General information

NPI: 1043578990
Provider Name (Legal Business Name): PABLO DIAZ-COLLADO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2012
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 PARKER HILL AVENUE CONVERSE 4, SUITE 1
BOSTON MA
02120-2847
US

IV. Provider business mailing address

125 PARKER HILL AVENUE CONVERSE 4, SUITE 1
BOSTON MA
02120-2847
US

V. Phone/Fax

Practice location:
  • Phone: 617-754-5471
  • Fax: 617-754-5740
Mailing address:
  • Phone: 617-754-5915
  • Fax: 617-754-5916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number275016
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: