Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | G62456 | CA |
N | 111NI0900X | Internist | G62456 | CA |
N | 207RH0000X | Hematologist | G62456 | CA |
Y | 207RH0003X | Hematology & Oncology | G62456 | CA |
N | 207RX0202X | Medical Oncology | G62456 | CA |
NPI | 1275640294 |
---|---|
Provider Name | Mr. Mark Mcnamara |
First Address | Los Angeles, CA 90031-1309 |
Second Address | Pasadena, CA 91105-2684 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2006 |
Last Update Date | 29/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E71857 | (02) |