Healthcare Provider Details

I. General information

NPI: 1689698094
Provider Name (Legal Business Name): MARY ELIZABETH ESLICK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 SACHEM ST
NORWICH CT
06360-4201
US

IV. Provider business mailing address

59 SACHEM ST
NORWICH CT
06360-4201
US

V. Phone/Fax

Practice location:
  • Phone: 860-889-1351
  • Fax: 860-889-0319
Mailing address:
  • Phone: 860-889-1351
  • Fax: 860-889-0319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number031570
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number031570
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: