Individual provider Active NPI

Divya Vangala, M.D.

  • Pediatrics Physician
  • Somerville, MA
National Provider Identifier
1003349713
Registry record updated Aug 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
293243 Issued in MA
Practice address
33 Tower St
Somerville, MA 02143-1426
Phone
(617) 591-6300
NPI assigned
Apr 10, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 2020-02955 NC
Pediatrics Physician 208000000X 293243 MA Primary

Addresses

Primary practice location

33 Tower St
Somerville, MA 02143-1426

Mailing address

1493 Cambridge St
Cambridge, MA 02139-1099

Other identifiers 1

IdentifierTypeStateIssuer
2020-02955OtherNCMD LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221208000808 MA Practitioner - Pediatric Medicine 3779854732 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
293243MAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cambridge Public Health Commission Current Accepting new patients
Cambridge Public Health Commission CurrentSince Sep 12, 2022 Accepting new patients

Locations

1493 Cambridge St
Bldg Med
Cambridge, MA 02139

1493 Cambridge St
Cambridge, MA 02139
Phone (617) 665-1185

103 Garland St
Everett, MA 02149
Phone (617) 381-7150

236 Highland Ave
Somerville, MA 02143
Phone (617) 591-4440

Interoperability endpoints

  • Direct secure messaging: dvangala115144@direct.challiance.masshiway.net

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1491782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660176000000",
    "number": "1003349713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1493 CAMBRIDGE ST",
            "city": "CAMBRIDGE",
            "state": "MA",
            "postal_code": "021391099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33 TOWER ST",
            "city": "SOMERVILLE",
            "state": "MA",
            "postal_code": "021431426",
            "telephone_number": "617-591-6300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANGALA",
        "first_name": "DIVYA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-04-10",
        "last_updated": "2022-08-11",
        "certification_date": "2022-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NC",
            "license": "2020-02955",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MA",
            "license": "293243",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MD LICENSE",
            "identifier": "2020-02955",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Somerville, MA

Sources for this page

Verify at the official NPI Registry.