Healthcare Provider Details

I. General information

NPI: 1114934080
Provider Name (Legal Business Name): GARRICK A APPLEBEE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 01/20/2022
Certification Date: 01/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UHC CAMPUS 1 SOUTH PROSPECT STREET
BURLINGTON VT
05401-3456
US

IV. Provider business mailing address

PO BOX 14890 SPHP PAYER CREDENTIALING
ALBANY NY
12212
US

V. Phone/Fax

Practice location:
  • Phone: 802-847-5338
  • Fax:
Mailing address:
  • Phone: 518-591-1121
  • Fax: 518-649-4094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080S0012X
TaxonomyPediatric Sleep Medicine Physician
License Number042-0010926
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License Number281927
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: