Provider Demographics
NPI:1003445982
Name:PUBBI, DIVYA (DO)
Entity Type:Individual
Prefix:
First Name:DIVYA
Middle Name:
Last Name:PUBBI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 FOULK RD STE 101
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-2769
Mailing Address - Country:US
Mailing Address - Phone:302-655-3242
Mailing Address - Fax:
Practice Address - Street 1:1405 FOULK RD STE 101
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-2769
Practice Address - Country:US
Practice Address - Phone:302-655-3242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-03
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program