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1205823986

NPI Code Detail

MEDICARE: DR. MARY C HARBOR MD

MEDICARE: DR. MARY C HARBOR MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	01043329	IN
2	208000000X	Pediatrics Physician	MD28620	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205823986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY C HARBOR MD

Provider Business Mailing Address
First Line	:	2435 NE CUMULUS AVE STE A
Second Line	:
City	:	MCMINNVILLE
State	:	OR
Zip	:	97128-8862
Country	:	US
Telephone Number	:	503-472-6161
Fax Number	:	503-434-8486

Provider Business Practice Location Address
First Line	:	2435 NE CUMULUS AVE STE A
Second Line	:
City	:	MCMINNVILLE
State	:	OR
Zip	:	97128-8862
Country	:	US
Telephone Number	:	503-472-6161
Fax Number	:	503-434-8486

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2005
Last Update Date	:	01/09/2013

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Directions to “ DR. MARY C HARBOR MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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