Provider Demographics
NPI:1881670206
Name:MCNAMARA, MARY PHILLIS (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:PHILLIS
Last Name:MCNAMARA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:P
Other - Last Name:MCNAMARA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:7550 LUCERNE DR
Mailing Address - Street 2:SUITE 405
Mailing Address - City:MIDDLEBURG HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-6588
Mailing Address - Country:US
Mailing Address - Phone:440-234-8833
Mailing Address - Fax:440-234-3313
Practice Address - Street 1:2908 ORCHARD TREE LN
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43617-2329
Practice Address - Country:US
Practice Address - Phone:419-266-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-17
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35047142207RI0200X
NC2015-02367207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0749622Medicaid
440003489OtherRAILROAD MEDICARE
OHMC0512466Medicare PIN