Provider Demographics
NPI:1417245713
Name:MCNAMARA, JEREMIAH E (MD)
Entity Type:Individual
Prefix:
First Name:JEREMIAH
Middle Name:E
Last Name:MCNAMARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 S MONACO ST STE 210
Mailing Address - Street 2:600 HIGHLAND AVE, H4/831
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-3487
Mailing Address - Country:US
Mailing Address - Phone:303-788-6657
Mailing Address - Fax:303-788-8837
Practice Address - Street 1:10103 RIDGEGATE PKWY STE 200
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5525
Practice Address - Country:US
Practice Address - Phone:303-788-6657
Practice Address - Fax:303-788-8837
Is Sole Proprietor?:No
Enumeration Date:2011-07-20
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.005555207V00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO02820056Medicaid
COP01634503Medicare PIN
CO466361YTU0Medicare PIN