Provider Demographics
NPI:1104864867
Name:MCNAMARA, VISCONTI & ASSOCIATES PLC
Entity Type:Organization
Organization Name:MCNAMARA, VISCONTI & ASSOCIATES PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:VISCONTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:989-705-1100
Mailing Address - Street 1:PO BOX 428
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-0428
Mailing Address - Country:US
Mailing Address - Phone:231-775-6076
Mailing Address - Fax:231-775-0027
Practice Address - Street 1:2922 D AND M DR
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-7417
Practice Address - Country:US
Practice Address - Phone:989-705-1100
Practice Address - Fax:989-705-1104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0N43440Medicare ID - Type Unspecified