Basic Information
| Provider Information | |||||||||
| NPI: | 1962848358 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MACNAMARA | ||||||||
| FirstName: | MARINA | ||||||||
| MiddleName: | MEGHAN CAITLIN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 603250 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282603250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282131500 | ||||||||
| FaxNumber: | 8286516570 | ||||||||
| Practice Location | |||||||||
| Address1: | 360 HOSPITAL DR | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | CLYDE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287210107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8284569006 | ||||||||
| FaxNumber: | 8284568199 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2013 | ||||||||
| LastUpdateDate: | 01/12/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 2015-00558 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.