Provider Demographics
NPI:1184835746
Name:APPLEDORE MEDICAL GROUP II
Entity Type:Organization
Organization Name:APPLEDORE MEDICAL GROUP II
Other - Org Name:COASTAL CARDIOTHROACIC & 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:M
Authorized Official - Last Name:PROFIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-559-4167
Mailing Address - Street 1:333 BORTHWICK AVE
Mailing Address - Street 2:SUITE 402
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:
Practice Address - Street 1:333 BORTHWICK AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-7128
Practice Address - Country:US
Practice Address - Phone:603-559-4111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHAPRE7462Medicare ID - Type UnspecifiedNH MEDICARE GROUP NUMBER