Provider Demographics
NPI:1952849473
Name:DR. BERNARD MCNAMARA MD INC
Entity Type:Organization
Organization Name:DR. BERNARD MCNAMARA MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:T
Authorized Official - Last Name:MCNAMARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-855-2981
Mailing Address - Street 1:409 N PACIFIC COAST HWY STE 923
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-6853
Mailing Address - Country:US
Mailing Address - Phone:818-855-2981
Mailing Address - Fax:
Practice Address - Street 1:409 N PACIFIC COAST HWY STE 923
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-6853
Practice Address - Country:US
Practice Address - Phone:818-855-2981
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-03
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG 36838207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA 46831Medicare UPIN