Provider Demographics
NPI:1457425720
Name:MCNAMARA, STEPHEN JACOBS (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:JACOBS
Last Name:MCNAMARA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:914 E HIGH ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-4850
Mailing Address - Country:US
Mailing Address - Phone:434-296-0808
Mailing Address - Fax:434-979-1123
Practice Address - Street 1:300 PRESTON AVENUE
Practice Address - Street 2:SUITE 214
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902
Practice Address - Country:US
Practice Address - Phone:434-296-0808
Practice Address - Fax:434-296-6050
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010489382084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
G05856Medicare UPIN