Healthcare Provider Details

I. General information

NPI: 1356392203
Provider Name (Legal Business Name): TODD DAVID APPLEGATE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 07/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 PEQUOT PARK RD SUITE 201A
WESTBROOK CT
06498-2856
US

IV. Provider business mailing address

5 PEQUOT PARK RD SUITE 201A
WESTBROOK CT
06498-2856
US

V. Phone/Fax

Practice location:
  • Phone: 860-391-8068
  • Fax:
Mailing address:
  • Phone: 860-391-8068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number044333
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number044333
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: