Provider Demographics
NPI:1255437752
Name:APPLEGATE, BRENDA LOUISE (MD)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:LOUISE
Last Name:APPLEGATE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 VOLUNTOWN RD
Mailing Address - Street 2:
Mailing Address - City:PAWCATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06379-1366
Mailing Address - Country:US
Mailing Address - Phone:860-599-5477
Mailing Address - Fax:860-599-5676
Practice Address - Street 1:91 VOLUNTOWN RD
Practice Address - Street 2:
Practice Address - City:PAWCATUCK
Practice Address - State:CT
Practice Address - Zip Code:06379-1366
Practice Address - Country:US
Practice Address - Phone:860-599-5477
Practice Address - Fax:860-599-5676
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2013-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT035827207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT3369438OtherAETNA HMO ID
CT5051525OtherAETNA INS ID
CT510427677OtherCOMMERCIAL PLANS ID
CT741490OtherCONNECTICARE ID
CT001358276Medicaid
CT510427677OtherTRICARE
CT510427677OtherUNITED HEALTH CARE
CTP805740OtherOXFORD ID
CT2V2718OtherHEALTH NET ID
CT510427677OtherCIGNA
CT010035827CT02OtherBCBS OF CT ID
CT080001576Medicare ID - Type UnspecifiedMEDICARE ID
CT510427677OtherUNITED HEALTH CARE