Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Divya Mallam, MD

Individual provider Gastroenterology Physician · NPI 1437437613

Divya Mallam, MD is a Gastroenterology in New York, New York. Qualified in 2011, 15 years ago. Practices with Aurora Medical Group, Inc, a 3,741-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in California, New York and Wisconsin.

Years since qualifying
15
Licensed in
CA, NY, WI
In the registry since
2011
Specialties on file
3
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

80 Maiden Ln Rm 1204
New York, NY 10038-4721
Phone: (212) 427-8761
Fax: (212) 427-8762
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 855 N Westhaven Dr, Oshkosh, WI 54904-7668 — (920) 303-8700

Specialties & licences

Gastroenterology Physician (primary) Taxonomy 207RG0100X · Licence 103660-875 (WI)
Gastroenterology Physician Taxonomy 207RG0100X · Licence A123488 (CA)
Gastroenterology Physician Taxonomy 207RG0100X · Licence 328761 (NY)

Record details

NPI number1437437613
Entity typeIndividual (Type 1)
GenderFemale
Credentials MD
Sole proprietorNo
NPI enumeratedJuly 22, 2011
Last updated in NPPESJuly 14, 2026
Certification dateJuly 14, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyGASTROENTEROLOGY
Medical schoolOTHER
Graduated 2011 (15 years in practice)
Group practice Aurora Medical Group, Inc. — 3741 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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