Provider Demographics
NPI:1356392203
Name:APPLEGATE, TODD DAVID (DO)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:DAVID
Last Name:APPLEGATE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 PEQUOT PARK RD
Mailing Address - Street 2:SUITE 201A
Mailing Address - City:WESTBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06498-2856
Mailing Address - Country:US
Mailing Address - Phone:860-391-8068
Mailing Address - Fax:
Practice Address - Street 1:5 PEQUOT PARK RD
Practice Address - Street 2:SUITE 201A
Practice Address - City:WESTBROOK
Practice Address - State:CT
Practice Address - Zip Code:06498-2856
Practice Address - Country:US
Practice Address - Phone:860-391-8068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT044333207XS0117X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT044333OtherCT LISCENSE
CT6171670002Medicare NSC
CT044333OtherCT LISCENSE
I54896Medicare UPIN