Provider Demographics
NPI:1609034438
Name:PYTLIK ELLISON, MARYBETH (MD)
Entity Type:Individual
Prefix:
First Name:MARYBETH
Middle Name:
Last Name:PYTLIK ELLISON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARYBETH
Other - Middle Name:PYTLIK
Other - Last Name:ELLISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:16 SURREY DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:CT
Mailing Address - Zip Code:06422-3312
Mailing Address - Country:US
Mailing Address - Phone:860-262-2462
Mailing Address - Fax:860-365-9300
Practice Address - Street 1:SUNFLOWER DEVELOPMENTAL PEDIATRICS
Practice Address - Street 2:11 WILDWOOD MEDICAL CENTER
Practice Address - City:ESSEX
Practice Address - State:CT
Practice Address - Zip Code:06426
Practice Address - Country:US
Practice Address - Phone:860-365-9300
Practice Address - Fax:860-365-9300
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-29
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT033211208000000X, 2080P0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics