Provider Demographics
NPI:1841248341
Name:APPLEGATE, MARY S (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:S
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 1:140 COLEMANS CROSSING BOULEVARD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-0000
Mailing Address - Country:US
Mailing Address - Phone:937-644-1441
Mailing Address - Fax:937-642-7760
Practice Address - Street 1:140 COLEMANS CROSSING BOULEVARD
Practice Address - Street 2:SUITE 210
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-0000
Practice Address - Country:US
Practice Address - Phone:937-644-1441
Practice Address - Fax:937-642-7760
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35057093207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0725559Medicaid
OHE92028Medicare UPIN
OH0725559Medicaid