Healthcare Provider Details

I. General information

NPI: 1144212838
Provider Name (Legal Business Name): MICHAEL J TOTTA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 11/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 SPRING ST
SCARBOROUGH ME
04074-8926
US

IV. Provider business mailing address

300 SOUTHBOROUGH DR SUITE 201
SOUTH PORTLAND ME
04106-6914
US

V. Phone/Fax

Practice location:
  • Phone: 207-885-0011
  • Fax: 207-885-5851
Mailing address:
  • Phone: 207-661-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMD12975
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: