Provider Demographics
NPI:1366852790
Name:TOTTA, LAURA (RD, LD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:TOTTA
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:
Other - Last Name:FRANK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:301C US ROUTE 1
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-9701
Mailing Address - Country:US
Mailing Address - Phone:207-396-8695
Mailing Address - Fax:207-396-8632
Practice Address - Street 1:1577 CONGRESS ST STE 3
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2169
Practice Address - Country:US
Practice Address - Phone:207-662-5210
Practice Address - Fax:207-772-3098
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-07
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MED1389133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered