1619954658 NPI number — DR. DAVID A DIAMOND MD

Table of content: DR. DAVID A DIAMOND MD (NPI 1619954658)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619954658 NPI number — DR. DAVID A DIAMOND MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIAMOND
Provider First Name:
DAVID
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619954658
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 LONGWOOD AVE
Provider Second Line Business Mailing Address:
CHILDRENS UROLOGICAL FOUNDATION
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02115-5724
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-730-0474
Provider Business Mailing Address Fax Number:
617-355-8338

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 LONGWOOD AVE
Provider Second Line Business Practice Location Address:
CHILDRENS UROLOGICAL FOUNDATION
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02115-5724
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-355-8338
Provider Business Practice Location Address Fax Number:
617-730-0474
Provider Enumeration Date:
12/30/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  308942 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208800000X , with the licence number: 52996 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3072791 . This is a "WCT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 732016 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1900273 . This is a "UNI4" identifier . This identifiers is of the category "OTHER".
  • Identifier: AA8296 . This is a "HPHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1900273 . This is a "UHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4321198002 . This is a "CIG2" identifier . This identifiers is of the category "OTHER".
  • Identifier: 93183 . This is a "FCHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 11273 . This is a "HNE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1900273 . This is a "METRA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 30007318 . This is a "WNH" identifier . This identifiers is of the category "OTHER".
  • Identifier: P2781842 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000009230 . This is a "BMC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1900273 . This is a "UNI7" identifier . This identifiers is of the category "OTHER".
  • Identifier: 991939 . This is a "NETHE" identifier . This identifiers is of the category "OTHER".
  • Identifier: Z11048 . This is a "HEALT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1900273 . This is a "UNI1" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0000871 . This is a "NHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6192653 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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