Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0000X | Obstetrician | 25MA02399100 | NJ |
NPI | 1083687164 |
---|---|
Provider Name | Dr. Robert Mcnamara |
First Address | Newark, NJ 07189-0001 |
Second Address | Summit, NJ 07901-3533 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C58626 | (02) | NJ |