Provider Demographics
NPI:1205943966
Name:APPLEGATE, RUSSEL C (MD)
Entity type:Individual
Prefix:
First Name:RUSSEL
Middle Name:C
Last Name:APPLEGATE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1098 W BALTIMORE PIKE
Mailing Address - Street 2:SUITE 3403 RIDDLE HLTH CTR 3
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-5139
Mailing Address - Country:US
Mailing Address - Phone:610-627-4490
Mailing Address - Fax:610-627-4477
Practice Address - Street 1:1098 W BALTIMORE PIKE
Practice Address - Street 2:SUITE 3403 RIDDLE HLTH CTR 3
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-5139
Practice Address - Country:US
Practice Address - Phone:610-627-4490
Practice Address - Fax:610-627-4477
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD021617E208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE63638Medicare UPIN
PA0006705360002Medicaid
PA189779HK1Medicare PIN