Healthcare Provider Details

I. General information

NPI: 1790947182
Provider Name (Legal Business Name): MARY ONITA HERBERT-GRANT MB BS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY HEBERT

II. Dates (important events)

Enumeration Date: 06/27/2008
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 MEDICAL CENTER PKWY
AUGUSTA ME
04330-8160
US

IV. Provider business mailing address

35 MEDICAL CENTER PKWY
AUGUSTA ME
04330-8160
US

V. Phone/Fax

Practice location:
  • Phone: 207-626-1000
  • Fax: 207-621-7277
Mailing address:
  • Phone: 207-626-1000
  • Fax: 207-621-7277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License NumberMD18730
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: