Provider Demographics
NPI:1790947182
Name:HERBERT, MARY ONITA (MB BS)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ONITA
Last Name:HERBERT
Suffix:
Gender:F
Credentials:MB BS
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:ONITA
Other - Last Name:HERBERT-GRANT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MB BS
Mailing Address - Street 1:43 WHITING HILL RD STE 300
Mailing Address - Street 2:
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1006
Mailing Address - Country:US
Mailing Address - Phone:207-973-8955
Mailing Address - Fax:207-973-9003
Practice Address - Street 1:489 STATE ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6616
Practice Address - Country:US
Practice Address - Phone:207-973-4051
Practice Address - Fax:207-973-9003
Is Sole Proprietor?:No
Enumeration Date:2008-06-27
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD187302080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases