Provider Demographics
NPI:1457305385
Name:TOTTEN, LARRY KENT (MD)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:KENT
Last Name:TOTTEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 INDEPENDENCE PT
Mailing Address - Street 2:STE 212
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4545
Mailing Address - Country:US
Mailing Address - Phone:864-797-6015
Mailing Address - Fax:
Practice Address - Street 1:1210 W FARIS RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4444
Practice Address - Country:US
Practice Address - Phone:864-295-4410
Practice Address - Fax:864-295-5694
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC59962085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC059965Medicaid
SCP00826282OtherRAILROAD MEDICARE
SCP00826282OtherRAILROAD MEDICARE
SCAA40196211Medicare PIN
SCP00826282OtherRAILROAD MEDICARE