Healthcare Provider Details

I. General information

NPI: 1275742421
Provider Name (Legal Business Name): APPLEDORE MEDICAL GRP II, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 BORTHWICK AVE STE 102
PORTSMOUTH NH
03801-4101
US

IV. Provider business mailing address

333 BORTHWICK AVE STE 402
PORTSMOUTH NH
03801-7128
US

V. Phone/Fax

Practice location:
  • Phone: 603-559-4111
  • Fax: 603-559-4110
Mailing address:
  • Phone: 603-559-4111
  • Fax: 603-559-4110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: SUZETTE PROFIO
Title or Position: PRACTICE MANAGER
Credential:
Phone: 603-559-4167