Provider Demographics
NPI:1134105075
Name:HERBERT, WILLIAM E (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:E
Last Name:HERBERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:887 CONGRESS ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-3100
Mailing Address - Country:US
Mailing Address - Phone:207-774-6368
Mailing Address - Fax:207-774-9388
Practice Address - Street 1:887 CONGRESS ST
Practice Address - Street 2:SUITE 400
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3100
Practice Address - Country:US
Practice Address - Phone:207-774-6368
Practice Address - Fax:207-774-9388
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ME010628208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30001049Medicaid
ME020000198OtherRR MEDICARE
ME288070099Medicaid
NH30001049Medicaid
MEAX4693Medicare PIN