Provider Demographics
NPI:1205823986
Name:HARBOR, MARY C (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:C
Last Name:HARBOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:C
Other - Last Name:AGUIAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2435 NE CUMULUS AVE STE A
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-8862
Mailing Address - Country:US
Mailing Address - Phone:503-472-6161
Mailing Address - Fax:503-434-8486
Practice Address - Street 1:2435 NE CUMULUS AVE STE A
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-8862
Practice Address - Country:US
Practice Address - Phone:503-472-6161
Practice Address - Fax:503-434-8486
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01043329208000000X
ORMD28620208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200045150AMedicaid
OR023682Medicaid
OR023682Medicaid
IN200045150AMedicaid
IN182790IMedicare PIN