MEDICARE: DIVYA MUDUMBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DN1858852	MA
2	122300000X	Dentist	04592	NH

General Provider Information

NPI Number	:	1518579499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIVYA MUDUMBA

Provider Business Mailing Address
First Line	:	515 SOUTH ST
Second Line	:
City	:	PITTSFIELD
State	:	MA
Zip	:	01201-8203
Country	:	US
Telephone Number	:	917-535-2935
Fax Number	:

Provider Business Practice Location Address
First Line	:	515 SOUTH ST
Second Line	:
City	:	PITTSFIELD
State	:	MA
Zip	:	01201-8203
Country	:	US
Telephone Number	:	917-535-2935
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2020
Last Update Date	:	02/19/2026

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Directions to “ DIVYA MUDUMBA ” Practice Location

Language	Start Address	Practice Location

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