Individual
DIVYA MAMOOTIL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
300 SEYMOUR AVE STE 202, DERBY, CT 06418-1343
(203) 732-2651
(203) 732-2654
Mailing address
300 SEYMOUR AVE STE 202, DERBY, CT 06418-1343
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
09/29/2025
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