Provider Demographics
NPI:1861477259
Name:MCNAMARA, MICHAEL D (DO)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:D
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 1:2 WALL ST STE 300
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03101-1518
Mailing Address - Country:US
Mailing Address - Phone:603-668-4111
Mailing Address - Fax:
Practice Address - Street 1:1555 ELM ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-1203
Practice Address - Country:US
Practice Address - Phone:603-668-4111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHT-07072084P0800X
VT3200004052084P0800X
NH166462084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1032740OtherCIGNA BEHAVIORAL HEALTH
VTVN0463Medicare ID - Type Unspecified
VT00018754OtherBLUE SHIELD OF VERMONT
F40794Medicare UPIN
VT260016005OtherRAILROAD MEDICARE
VT391760OtherMVP
VTOVN0463Medicaid