Provider Demographics
NPI:1417042805
Name:MCNAMARA, TERRENCE R (DO)
Entity Type:Individual
Prefix:
First Name:TERRENCE
Middle Name:R
Last Name:MCNAMARA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:458 OLD STREET RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PETERBOROUGH
Mailing Address - State:NH
Mailing Address - Zip Code:03458-1265
Mailing Address - Country:US
Mailing Address - Phone:603-924-2144
Mailing Address - Fax:
Practice Address - Street 1:458 OLD STREET RD
Practice Address - Street 2:SUITE 200
Practice Address - City:PETERBOROUGH
Practice Address - State:NH
Practice Address - Zip Code:03458-1265
Practice Address - Country:US
Practice Address - Phone:603-924-2144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN102519208100000X
NH14887208VP0000X
171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN809468000Medicaid
IAENROLLEDMedicaid
MN250000719Medicare PIN
MNP00733617OtherMEDICARE RAILROAD
WI37578100Medicaid
MNI 61284Medicare UPIN