Provider Demographics
NPI:1831537091
Name:MCNAMARA, MEREDITHE CLAIRE (MD)
Entity type:Individual
Prefix:
First Name:MEREDITHE
Middle Name:CLAIRE
Last Name:MCNAMARA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 S STATE ST
Mailing Address - Street 2:APT 908
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-3623
Mailing Address - Country:US
Mailing Address - Phone:201-315-6093
Mailing Address - Fax:
Practice Address - Street 1:5721 S MARYLAND AVE # MC8000
Practice Address - Street 2:SUITE K160
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637
Practice Address - Country:US
Practice Address - Phone:201-315-6093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-10
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125063260208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL125063260Medicaid