Provider Demographics
NPI:1124233044
Name:APPLEDORE MEDICAL GRP II, INC.
Entity Type:Organization
Organization Name:APPLEDORE MEDICAL GRP II, INC.
Other - Org Name:COASTAL CARDIOTHORACIC AND VASCULAR ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUZETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:PROFIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-559-4167
Mailing Address - Street 1:333 BORTHWICK AVE STE 402
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-7128
Mailing Address - Country:US
Mailing Address - Phone:603-559-4111
Mailing Address - Fax:603-559-4110
Practice Address - Street 1:16 HOSPITAL DR STE 101
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:ME
Practice Address - Zip Code:03909-1041
Practice Address - Country:US
Practice Address - Phone:207-351-3920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
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
NHAP RE7462Medicare ID - Type UnspecifiedGROUP MEDICARE, NH #