MEDICARE: APPLEDORE MEDICAL GROUP, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0200X	Infectious Disease Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407845050
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	APPLEDORE MEDICAL GROUP, INC

Provider Business Mailing Address
First Line	:	2000 HEALTH PARK DR
Second Line	:
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-4525
Country	:	US
Telephone Number	:	615-372-5426
Fax Number	:

Provider Business Practice Location Address
First Line	:	330 BORTHWICK AVE
Second Line	:	SUITE 200
City	:	PORTSMOUTH
State	:	NH
Zip	:	03801-4174
Country	:	US
Telephone Number	:	603-433-8733
Fax Number	:	603-433-8834

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	BEN CALKINS
Credential	:
Telephone Number	:	804-267-5950

Provider Enumeration Date	:	10/17/2005
Last Update Date	:	11/07/2017

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