MEDICARE: APPLEDORE MEDICAL GROUP, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700875085
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	APPLEDORE MEDICAL GROUP, INC.

Provider Business Mailing Address
First Line	:	55 HIGH ST
Second Line	:	SUITE 201
City	:	HAMPTON
State	:	NH
Zip	:	03842-2213
Country	:	US
Telephone Number	:	603-929-2137
Fax Number	:	603-929-7482

Provider Business Practice Location Address
First Line	:	55 HIGH ST
Second Line	:	SUITE 201
City	:	HAMPTON
State	:	NH
Zip	:	03842-2213
Country	:	US
Telephone Number	:	603-929-2137
Fax Number	:	603-929-7482

Authorized Official
Title or Position	:	VP
Name	:	MR. KENNETH WASHINGTON
Credential	:
Telephone Number	:	703-650-2907

Provider Enumeration Date	:	10/19/2005
Last Update Date	:	08/06/2007

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