Groth, Mary Elizabeth

Groth, Mary Elizabeth is an individual health care provider with primary practice located at 59 Lyme Street , Old Lyme CT 06371. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Pediatrics, which is considered as her primary health care specialty. Groth, Mary Elizabeth can be contacted via phone (860) 373-6208.

Contact Information

Primary practice address
59 Lyme Street Old Lyme CT 06371
Phone: (860) 373-6208
Fax: (860) 434-1580
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Pediatrics 363LP0200X 001632 Connecticut

Profile Details

NPI number 1508849076
LBN Legal business name Groth, Mary Elizabeth
Credentials A.P.R.N., P.M.H.S.
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 29th, 2005
Last updated Dec 12th, 2017 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1508849076 NPPES
Connecticut MEDICAID 004200391

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