1255437752 NPI number — BRENDA LOUISE APPLEGATE M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255437752 NPI number — BRENDA LOUISE APPLEGATE M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

APPLEGATE

Provider First Name:

BRENDA

Provider Middle Name:

LOUISE

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

F

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:

1255437752

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

01/19/2013

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

91 VOLUNTOWN RD

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

PAWCATUCK

Provider Business Mailing Address State Name:

CT

Provider Business Mailing Address Postal Code:

06379-1366

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

860-599-5477

Provider Business Mailing Address Fax Number:

860-599-5676

Provider First Line Business Practice Location Address:

91 VOLUNTOWN RD

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

PAWCATUCK

Provider Business Practice Location Address State Name:

CT

Provider Business Practice Location Address Postal Code:

06379-1366

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

860-599-5477

Provider Business Practice Location Address Fax Number:

860-599-5676

Provider Enumeration Date:

09/15/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207Q00000X , with the licence number:  035827 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 3369438 . This is a "AETNA HMO ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: 5051525 . This is a "AETNA INS ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: 510427677 . This is a "COMMERCIAL PLANS ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: 741490 . This is a "CONNECTICARE ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: 001358276 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
• Identifier: 510427677 . This is a "TRICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: 510427677 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: P805740 . This is a "OXFORD ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: 2V2718 . This is a "HEALTH NET ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: 510427677 . This is a "CIGNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: 010035827CT02 . This is a "BCBS OF CT ID" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".