Provider Demographics
NPI:1932166345
Name:MCNAMARA, BONNIE L (MD)
Entity Type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:L
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 1:2221 HAYES AVE
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420-2632
Mailing Address - Country:US
Mailing Address - Phone:419-334-8943
Mailing Address - Fax:419-334-8619
Practice Address - Street 1:1005 BELLEFONTAINE AVE STE 300
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45804-2881
Practice Address - Country:US
Practice Address - Phone:419-334-3869
Practice Address - Fax:419-334-8546
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35062425207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000201718OtherANTHEM
OH080164655OtherRAILROAD MEDICARE
OH03887OtherPARAMOUNT
OH0935699Medicaid
OH735050OtherBUCKEYE
OH735050OtherBUCKEYE
OHMC0744192Medicare PIN
OHMC0744193Medicare PIN