Provider Demographics
NPI:1114113040
Name:APPLEDORE MEDICAL GROUP II INC
Entity Type:Organization
Organization Name:APPLEDORE MEDICAL GROUP II INC
Other - Org Name:COASTAL CARDIOTHORACIC & VASCULAR ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-650-2907
Mailing Address - Street 1:12 HOSPITAL DR
Mailing Address - Street 2:SUITE 9
Mailing Address - City:YORK
Mailing Address - State:ME
Mailing Address - Zip Code:03909-1030
Mailing Address - Country:US
Mailing Address - Phone:603-433-4862
Mailing Address - Fax:603-334-2052
Practice Address - Street 1:12 HOSPITAL DR
Practice Address - Street 2:SUITE 9
Practice Address - City:YORK
Practice Address - State:ME
Practice Address - Zip Code:03909-1030
Practice Address - Country:US
Practice Address - Phone:603-433-4862
Practice Address - Fax:603-334-2052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30212551Medicaid
NH30212551Medicaid