Provider Demographics
NPI:1407871411
Name:MCNAMARA, GREGORY JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:JOHN
Last Name:MCNAMARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:811 2ND ST SE
Mailing Address - Street 2:SUITE A
Mailing Address - City:LITTLE FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56345-3559
Mailing Address - Country:US
Mailing Address - Phone:320-631-7000
Mailing Address - Fax:320-632-0534
Practice Address - Street 1:811 2ND ST SE
Practice Address - Street 2:SUITE A
Practice Address - City:LITTLE FALLS
Practice Address - State:MN
Practice Address - Zip Code:56345-3559
Practice Address - Country:US
Practice Address - Phone:320-631-7000
Practice Address - Fax:320-632-0534
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN35954207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1M278MCOtherBCBS OF MINNESOTA
0125649OtherMEDICA
21628OtherAMERICA'S PPO
MNA006OtherTRICARE
MN151029C736OtherUCARE MINNESOTA
HP11014OtherHEALTH PARTNERS
MN005272800Medicaid
NA9230454509OtherPREFERRED ONE
HP11014OtherHEALTH PARTNERS
MNA006OtherTRICARE
NA9230454509OtherPREFERRED ONE