Individual
DIVYA VANGALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
33 TOWER ST, SOMERVILLE, MA 02143-1426
(617) 591-6300
Mailing address
1493 CAMBRIDGE ST, CAMBRIDGE, MA 02139-1099
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
2020-02955
NC
208000000X
Pediatrics Physician
Primary
293243
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2020-02955
MD LICENSE
NC
Enumeration date
04/10/2017
Last updated
08/11/2022
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