Healthcare Provider Details

I. General information

NPI: 1861924961
Provider Name (Legal Business Name): DIVYA AYYALA-SOMAYAJULA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DIVYA AYYALA- SOMAYAJULA

II. Dates (important events)

Enumeration Date: 03/29/2017
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 S 10TH STREET 480 MAIN BUILDING
PHILADELPHIA PA
19107-5244
US

IV. Provider business mailing address

132 S 10TH STREET 480 MAIN BUILDING
PHILADELPHIA PA
19107-5244
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-8900
  • Fax:
Mailing address:
  • Phone: 215-955-8900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number25MA12395600
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD484695
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: