Basic Information
Provider Information | |||||||||
NPI: | 1417042805 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MCNAMARA | ||||||||
FirstName: | TERRENCE | ||||||||
MiddleName: | R | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | DO | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 458 OLD STREET RD | ||||||||
Address2: | SUITE 200 | ||||||||
City: | PETERBOROUGH | ||||||||
State: | NH | ||||||||
PostalCode: | 034581265 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6039242144 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 458 OLD STREET RD | ||||||||
Address2: | SUITE 200 | ||||||||
City: | PETERBOROUGH | ||||||||
State: | NH | ||||||||
PostalCode: | 034581265 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6039242144 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/03/2006 | ||||||||
LastUpdateDate: | 05/05/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 05/05/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 102519 | MN | N |   | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |   | 208VP0000X | 14887 | NH | Y |   | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | 171100000X |   |   | N |   | Other Service Providers | Acupuncturist |   |
No ID Information.