Provider Demographics
NPI:1679262711
Name:MCNAMARA, ANNA KATHLEEN
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:KATHLEEN
Last Name:MCNAMARA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 BODENHORN RD
Mailing Address - Street 2:
Mailing Address - City:SLIGO
Mailing Address - State:PA
Mailing Address - Zip Code:16255-4426
Mailing Address - Country:US
Mailing Address - Phone:814-227-9285
Mailing Address - Fax:
Practice Address - Street 1:767 5TH AVE STE B3-A
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-4207
Practice Address - Country:US
Practice Address - Phone:717-709-7940
Practice Address - Fax:717-263-8014
Is Sole Proprietor?:No
Enumeration Date:2023-05-04
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS044167122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist