Provider Demographics
NPI:1053380816
Name:APPLEBAUM, GARY ELLIOT (MD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:ELLIOT
Last Name:APPLEBAUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10845 PHILADELPHIA RD
Mailing Address - Street 2:
Mailing Address - City:WHITE MARSH
Mailing Address - State:MD
Mailing Address - Zip Code:21162-1717
Mailing Address - Country:US
Mailing Address - Phone:410-335-0008
Mailing Address - Fax:410-335-1133
Practice Address - Street 1:42 LATIMORE WAY
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-6000
Practice Address - Country:US
Practice Address - Phone:410-627-8859
Practice Address - Fax:410-363-2023
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0034053207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00745580OtherRAILROAD MEDICARE
MD40035806OtherCAREFIRST
MD152843ZDS4OtherMEDICARE
MD285211000OtherMEDICAL ASSISTANCE
DCQ467-0001OtherCAREFIRST
MD40035806OtherCAREFIRST