Provider Demographics
NPI:1962900365
Name:MCNAMARA, MARILYN (MD)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:
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 1:1031 BROOK LN
Mailing Address - Street 2:
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-2184
Mailing Address - Country:US
Mailing Address - Phone:216-272-4034
Mailing Address - Fax:
Practice Address - Street 1:1031 BROOK LN
Practice Address - Street 2:
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-2184
Practice Address - Country:US
Practice Address - Phone:216-272-4034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-31
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-0409632086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery