Provider Demographics
NPI:1093898124
Name:TILTON, LINDA LEE (RD, CDE)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:LEE
Last Name:TILTON
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 S PROSPECT ST
Mailing Address - Street 2:FAHC, ARNOLD 3435 UHC CAMPUS
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-3456
Mailing Address - Country:US
Mailing Address - Phone:802-847-5091
Mailing Address - Fax:802-847-3401
Practice Address - Street 1:1 S PROSPECT ST
Practice Address - Street 2:FAHC ST. JOSEPH'S 5TH FLOOR, UHC CAMPUS
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-3456
Practice Address - Country:US
Practice Address - Phone:802-847-4576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT074-0000100133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TI MT0020Medicare UPIN