Provider Demographics
NPI:1972592251
Name:APPLEDORE MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:APPLEDORE MEDICAL GROUP, INC.
Other - Org Name:DBA MARK HENSCHKE DO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:BIRMINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-373-7625
Mailing Address - Street 1:2064 WOODBURY AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NEWINGTON
Mailing Address - State:NH
Mailing Address - Zip Code:03801-7801
Mailing Address - Country:US
Mailing Address - Phone:603-766-8130
Mailing Address - Fax:603-766-8131
Practice Address - Street 1:2064 WOODBURY AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:NEWINGTON
Practice Address - State:NH
Practice Address - Zip Code:03801-7801
Practice Address - Country:US
Practice Address - Phone:603-766-8130
Practice Address - Fax:603-766-8131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-19
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME14235000Medicaid
ME14235000Medicaid