Provider Demographics
NPI:1871933051
Name:SANGAMESWARAN, KOTHAI DIVYA GURUSWAMY (MD)
Entity type:Individual
Prefix:
First Name:KOTHAI DIVYA
Middle Name:GURUSWAMY
Last Name:SANGAMESWARAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KOTHAI DIVYA
Other - Middle Name:GURUSWAMY
Other - Last Name:SANGAMESWARAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:557 SANDHURST DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-4433
Mailing Address - Country:US
Mailing Address - Phone:910-484-8114
Mailing Address - Fax:910-223-0511
Practice Address - Street 1:557 SANDHURST DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4433
Practice Address - Country:US
Practice Address - Phone:910-484-8114
Practice Address - Fax:910-223-0511
Is Sole Proprietor?:No
Enumeration Date:2013-07-02
Last Update Date:2025-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK32956207RN0300X
NC2020-00969207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology