Provider Demographics
NPI:1568462836
Name:MCNAMARA, LORETTA LEWIS (MD)
Entity Type:Individual
Prefix:
First Name:LORETTA
Middle Name:LEWIS
Last Name:MCNAMARA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8308 CONSTITUTION PL NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-7637
Mailing Address - Country:US
Mailing Address - Phone:505-293-1333
Mailing Address - Fax:505-293-4357
Practice Address - Street 1:8308 CONSTITUTION PL NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-7637
Practice Address - Country:US
Practice Address - Phone:505-293-1333
Practice Address - Fax:505-293-4357
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM89-73208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM20326OtherPHP PROVIDER NUMBER
NMNM000843OtherBCBS PROVIDER NUMBER
NM006OtherCIMARRON HEALTH PLAN