Individual
DIVYA MALLAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
80 MAIDEN LN RM 1204, NEW YORK, NY 10038-4721
(212) 427-8761
(212) 427-8762
Mailing address
80 MAIDEN LN RM 1204, NEW YORK, NY 10038-4721
(212) 427-8761
(212) 427-8762
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
103660-875
WI
207RG0100X
Gastroenterology Physician
328761
NY
207RG0100X
Gastroenterology Physician
A123488
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100415064
—
WI
Enumeration date
07/22/2011
Last updated
07/14/2026
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