Provider Demographics
NPI:1225037906
Name:DIVARI, KATYA (MD)
Entity type:Individual
Prefix:DR
First Name:KATYA
Middle Name:
Last Name:DIVARI
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 1:336 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-6355
Mailing Address - Country:US
Mailing Address - Phone:150-887-2200
Mailing Address - Fax:
Practice Address - Street 1:336 UNION AVE
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-6355
Practice Address - Country:US
Practice Address - Phone:508-872-2002
Practice Address - Fax:508-872-2922
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2007-12-04
Deactivation Date:2006-03-18
Deactivation Code:
Reactivation Date:2006-03-30
Provider Licenses
StateLicense IDTaxonomies
MA075199207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism