Healthcare Provider Details

I. General information

NPI: 1598991036
Provider Name (Legal Business Name): APPLEBAUM VENTURES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2009
Last Update Date: 03/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 LATIMORE WAY
OWINGS MILLS MD
21117-6000
US

IV. Provider business mailing address

10845 PHILADELPHIA RD
WHITE MARSH MD
21162-1717
US

V. Phone/Fax

Practice location:
  • Phone: 410-627-8859
  • Fax:
Mailing address:
  • Phone: 410-335-0008
  • Fax: 410-335-1133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: GARY ELLIOTT APPLEBAUM
Title or Position: OWNER
Credential: M.D.
Phone: 410-627-8859