Basic Information
| Provider Information | |||||||||
| NPI: | 1619931656 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HEBERT | ||||||||
| FirstName: | ALBERT | ||||||||
| MiddleName: | JOSEPH | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 83 | ||||||||
| Address2: | |||||||||
| City: | LYNDONVILLE | ||||||||
| State: | VT | ||||||||
| PostalCode: | 058510083 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8027489501 | ||||||||
| FaxNumber: | 8027483420 | ||||||||
| Practice Location | |||||||||
| Address1: | 195 INDUSTRIAL PARKWAY | ||||||||
| Address2: | |||||||||
| City: | LYNDON | ||||||||
| State: | VT | ||||||||
| PostalCode: | 05849 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8027489501 | ||||||||
| FaxNumber: | 8027483420 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2006 | ||||||||
| LastUpdateDate: | 08/01/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 173000000X | 420010916 | VT | N | Other Service Providers | Legal Medicine | 207Q00000X | 042-0010916 | VT | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3076808 | 05 | NH | MEDICAID | 1011479 | 05 | VT | MEDICAID |