Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 044333 | CT |
Y | 207XS0117X | Orthopaedic Spine Surgeon | 044333 | CT |
NPI | 1356392203 |
---|---|
Provider Name | Todd David Applegate |
First Address | Westbrook, CT 06498-2856 |
Second Address | Westbrook, CT 06498-2856 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2006 |
Last Update Date | 09/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
044333 | CT LISCENSE (01) | CT |
I54896 | (02) |