Provider Demographics
NPI:1265523690
Name:TORTELLO, SUSAN M (RD)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:M
Last Name:TORTELLO
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 WATER ST
Mailing Address - Street 2:
Mailing Address - City:HOULTON
Mailing Address - State:ME
Mailing Address - Zip Code:04730-2105
Mailing Address - Country:US
Mailing Address - Phone:207-532-5538
Mailing Address - Fax:
Practice Address - Street 1:88 BELL RD STE 2
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:ME
Practice Address - Zip Code:04730-6704
Practice Address - Country:US
Practice Address - Phone:207-532-2440
Practice Address - Fax:207-532-2402
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME01707133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEP47512Medicare UPIN
METOMT0038Medicare ID - Type Unspecified