Provider Demographics
NPI:1245290394
Name:MCNAMARA, SONYA JUSTUS (PA-C)
Entity type:Individual
Prefix:
First Name:SONYA
Middle Name:JUSTUS
Last Name:MCNAMARA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SONYA
Other - Middle Name:
Other - Last Name:JUSTUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:195 FORE RIVER PKWY
Mailing Address - Street 2:SUITE 490
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2780
Mailing Address - Country:US
Mailing Address - Phone:207-553-6054
Mailing Address - Fax:207-553-6076
Practice Address - Street 1:195 FORE RIVER PKWY
Practice Address - Street 2:SUITE 490
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2780
Practice Address - Country:US
Practice Address - Phone:207-553-6054
Practice Address - Fax:207-553-6076
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2013-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAAP1899363AM0700X
MEPA001140363AM0700X
NH0783363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical