Provider Demographics
NPI:1043409741
Name:MARY E. ESLICK
Entity Type:Organization
Organization Name:MARY E. ESLICK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING DEPT.
Authorized Official - Prefix:MRS
Authorized Official - First Name:KERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:ATWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-823-1363
Mailing Address - Street 1:59 SACHEM ST
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-4201
Mailing Address - Country:US
Mailing Address - Phone:860-889-1351
Mailing Address - Fax:860-889-0319
Practice Address - Street 1:59 SACHEM ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-4201
Practice Address - Country:US
Practice Address - Phone:860-889-1351
Practice Address - Fax:860-889-0319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT031570207K00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTNLP085OtherOXFORD
CT010031570CT01OtherBC/BS
CT030079OtherHEALTHNET