Healthcare Provider Details

I. General information

NPI: 1639674138
Provider Name (Legal Business Name): BLAIR COLETTE MCNAMARA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2018
Last Update Date: 06/03/2022
Certification Date: 06/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 YORK ST
NEW HAVEN CT
06510-3220
US

IV. Provider business mailing address

100 CHURCH ST S # F201
NEW HAVEN CT
06519-1703
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-5188
  • Fax:
Mailing address:
  • Phone: 203-785-5188
  • Fax: 203-785-5163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA165553
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number70871
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: