Basic Information
| Provider Information | |||||||||
| NPI: | 1932166345 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCNAMARA | ||||||||
| FirstName: | BONNIE | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2221 HAYES AVE | ||||||||
| Address2: | |||||||||
| City: | FREMONT | ||||||||
| State: | OH | ||||||||
| PostalCode: | 434202632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4193348943 | ||||||||
| FaxNumber: | 4193348619 | ||||||||
| Practice Location | |||||||||
| Address1: | 1005 BELLEFONTAINE AVE STE 300 | ||||||||
| Address2: | |||||||||
| City: | LIMA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458042881 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4193343869 | ||||||||
| FaxNumber: | 4193348546 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2006 | ||||||||
| LastUpdateDate: | 08/02/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35062425 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000000201718 | 01 | OH | ANTHEM | OTHER | 080164655 | 01 | OH | RAILROAD MEDICARE | OTHER | 03887 | 01 | OH | PARAMOUNT | OTHER | 0935699 | 05 | OH | MEDICAID | 735050 | 01 | OH | BUCKEYE | OTHER |