Individual
PABLO I HERNANDEZ ITRIAGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
19 TACOMA ST, WORCESTER, MA 01605-3516
(508) 852-1805
Mailing address
650 LINCOLN ST, DOB 503, WORCESTER, MA 01605-2060
(508) 532-7318
(508) 852-8593
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
219852
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0006767
NHP-GROUP
MA
01
—
0033107
NHP
MA
01
—
042485308
NETWORK HEALTH-GROUP
MA
05
—
110090943A
—
MA
05
—
1300709
—
MA
01
—
70172
CMSP
MA
01
—
7674093
CIGNA
MA
01
—
90590
FALLON SELECT
MA
01
—
97000901
NETWORK HEALTH
MA
01
—
AA16802
HARVARD PILGRIM
MA
01
—
J28324
BCBS
MA
01
—
Y10141
BCBS-GROUP
MA
Enumeration date
08/10/2006
Last updated
07/01/2016
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