Provider Demographics
NPI:1609154186
Name:DUA, DIVYA KAUSHIK (MD)
Entity type:Individual
Prefix:
First Name:DIVYA
Middle Name:KAUSHIK
Last Name:DUA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:129 W 29TH ST # W
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-5105
Mailing Address - Country:US
Mailing Address - Phone:415-658-6791
Mailing Address - Fax:415-520-0904
Practice Address - Street 1:28 STATE ST
Practice Address - Street 2:SUITE 2860
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02109-1775
Practice Address - Country:US
Practice Address - Phone:617-903-5000
Practice Address - Fax:617-903-5009
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-01
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY269435-1207R00000X
MA261317207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine