1043263379 NPI number — GREGORY MCNAMARA D.P.M.

Table of content: GREGORY MCNAMARA D.P.M. (NPI 1043263379)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043263379 NPI number — GREGORY MCNAMARA D.P.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCNAMARA
Provider First Name:
GREGORY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.P.M.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043263379
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/31/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1807
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MERRIMACK
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03054-1807
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-673-9411
Provider Business Mailing Address Fax Number:
603-673-9899

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
33 BARTLETT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOWELL
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01852-1334
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-452-7233
Provider Business Practice Location Address Fax Number:
978-458-6430
Provider Enumeration Date:
05/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  1639 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 213E00000X , with the licence number: 0151 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 701125 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: Y70726 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1524676 . This is a "UNITED MINE WORKERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 98215702 . This is a "NETWORK HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0006112 . This is a "NEIGHBORHOOD HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 480022699 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 86560 . This is a "HEALTHSOURCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0307130Y0NH01 . This is a "ANTHEM BLUE CROSS" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 33217 . This is a "HARVARD PILGRIM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 80003645 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 042779503 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 20536 . This is a "FALLON COMMUNITY HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2700058 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".




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