Individual
DR. MARY BETH JANICKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
114 WOODLAND ST, HARTFORD, CT 06105-1208
(860) 714-4595
(860) 714-8008
Mailing address
1000 ASYLUM AVE, 2109A, HARTFORD, CT 06105-1770
(860) 714-6581
(860) 714-8311
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
041341
CT
207V00000X
Obstetrics & Gynecology Physician
041341
CT
207VM0101X
Maternal & Fetal Medicine Physician
Primary
041341
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
041341
LICENSE
CT
Enumeration date
09/27/2006
Last updated
06/16/2021
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