Healthcare Provider Details

I. General information

NPI: 1639126030
Provider Name (Legal Business Name): APPLEDORE MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 09/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 STATE RD
KITTERY ME
03904-1519
US

IV. Provider business mailing address

139 STATE RD
KITTERY ME
03904-1519
US

V. Phone/Fax

Practice location:
  • Phone: 207-439-2007
  • Fax:
Mailing address:
  • Phone: 207-439-2007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KENNETH WASHINGTON
Title or Position: VP
Credential:
Phone: 703-650-2907