1114934080 NPI number — GARRICK A APPLEBEE M.D.

Table of content: GARRICK A APPLEBEE M.D. (NPI 1114934080)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114934080 NPI number — GARRICK A APPLEBEE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
APPLEBEE
Provider First Name:
GARRICK
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114934080
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/20/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 14890
Provider Second Line Business Mailing Address:
SPHP PAYER CREDENTIALING
Provider Business Mailing Address City Name:
ALBANY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12212
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-591-1121
Provider Business Mailing Address Fax Number:
518-649-4094

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
UHC CAMPUS
Provider Second Line Business Practice Location Address:
1 SOUTH PROSPECT STREET
Provider Business Practice Location Address City Name:
BURLINGTON
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05401-3456
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-847-5338
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/02/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2080S0012X , with the licence number:  042-0010926 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207QS1201X , with the licence number: 281927 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)