Provider Demographics
NPI:1689698094
Name:ESLICK, MARY ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ELIZABETH
Last Name:ESLICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT031570207K00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT030079OtherHEALTHNET
CT722145OtherCONNECTICARE
CTNLP085OtherOXFORD
CT010031570CT01OtherBLUE CROSS/BLUE SHIELD
CT722145OtherCONNECTICARE