Healthcare Provider Details

I. General information

NPI: 1861924433
Provider Name (Legal Business Name): DIVYA NATESAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2017
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 MACON POND RD
RALEIGH NC
27607-6319
US

IV. Provider business mailing address

4101 MACON POND RD
RALEIGH NC
27607-6319
US

V. Phone/Fax

Practice location:
  • Phone: 919-781-7070
  • Fax:
Mailing address:
  • Phone: 410-430-4959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number2022-01230
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: