Healthcare Provider Details

I. General information

NPI: 1881683415
Provider Name (Legal Business Name): APPLEDORE MEDICAL GROUP II INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 04/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 BORTHWICK AVE SUITE 402
PORTSMOUTH NH
03801-7128
US

IV. Provider business mailing address

333 BORTHWICK AVE SUITE 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: WILLIAM T JOHNSON
Title or Position: VICE PRESIDENT
Credential:
Phone: 804-237-7760