Provider Demographics
NPI:1104825181
Name:APPLETON HEALTHCARE LLC
Entity Type:Organization
Organization Name:APPLETON HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:APPLETON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:703-352-7383
Mailing Address - Street 1:5422 BEECH RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-4618
Mailing Address - Country:US
Mailing Address - Phone:703-352-7383
Mailing Address - Fax:703-352-7383
Practice Address - Street 1:5422 BEECH RIDGE DR
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-4618
Practice Address - Country:US
Practice Address - Phone:703-352-7383
Practice Address - Fax:703-352-7383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPO384174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty