Provider Demographics
NPI:1225232184
Name:APPLEDORE MEDICAL GROUP DBA WOODBURY FAMILY PRACTICE
Entity Type:Organization
Organization Name:APPLEDORE MEDICAL GROUP DBA WOODBURY FAMILY PRACTICE
Other - Org Name:WOODBURY FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-650-2907
Mailing Address - Street 1:101 SHATTUCK WAY
Mailing Address - Street 2:SUITE 6
Mailing Address - City:NEWINGTON
Mailing Address - State:NH
Mailing Address - Zip Code:03801-7876
Mailing Address - Country:US
Mailing Address - Phone:603-430-0060
Mailing Address - Fax:866-835-8949
Practice Address - Street 1:101 SHATTUCK WAY
Practice Address - Street 2:SUITE 6
Practice Address - City:NEWINGTON
Practice Address - State:NH
Practice Address - Zip Code:03801-7876
Practice Address - Country:US
Practice Address - Phone:603-430-0060
Practice Address - Fax:866-835-8949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHRE3268Medicare ID - Type Unspecified