Provider Demographics
NPI:1124259858
Name:KESTUR RAJASEKHAR, DIVYA MANGALA (MD)
Entity type:Individual
Prefix:DR
First Name:DIVYA MANGALA
Middle Name:
Last Name:KESTUR RAJASEKHAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:273 FAIRWAY XING
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-1465
Mailing Address - Country:US
Mailing Address - Phone:469-487-9988
Mailing Address - Fax:
Practice Address - Street 1:1185 MAIN ST STE 4
Practice Address - Street 2:
Practice Address - City:WILLIMANTIC
Practice Address - State:CT
Practice Address - Zip Code:06226-2093
Practice Address - Country:US
Practice Address - Phone:860-423-7558
Practice Address - Fax:860-423-4694
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-29
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT53382207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology