Individual
DR. DIVYA MAMOOTIL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
300 SEYMOUR AVE STE 203B, DERBY, CT 06418-1343
(203) 516-5303
(203) 732-8136
Mailing address
67 MAPLE AVE, DERBY, CT 06418-1328
Taxonomy
Speciality
Code
Description
License number
State
207RR0500X
Rheumatology Physician
Primary
82939
CT
207RR0500X
Rheumatology Physician
MT231028
PA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/24/2021
Last updated
07/09/2026
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