Memolo, Mark William

Memolo, Mark William is an individual health care provider with primary practice located at 620 Summit Crossing Pl Ste 106, Gastonia NC 28054. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Diagnostic Radiology, Allopathic & Osteopathic Physicians / Vascular & Interventional Radiology. Allopathic & Osteopathic Physicians / Diagnostic Radiology is his primary health care specialty. Memolo, Mark William can be contacted via phone (704) 867-8021.

Contact Information

Primary practice address
620 Summit Crossing Pl Ste 106 Gastonia NC 28054
Phone: (704) 867-8021
Fax: (704) 864-4606
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X 33274 North Carolina
Allopathic & Osteopathic Physicians / Vascular & Interventional Radiology 2085R0204X 33274 North Carolina

Profile Details

NPI number 1386627115
LBN Legal business name Memolo, Mark William
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 25th, 2005
Last updated Aug 23rd, 2010 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1386627115 NPPES
Other 58609 BLUE CROSS BLUE SHIELD
MEDICAID N33274 BLUE CROSS BLUE SHIELD
Other 12402 BLUE CROSS BLUE SHIELD
Other 73411 BLUE CROSS BLUE SHIELD
MEDICAID 8958609 BLUE CROSS BLUE SHIELD
Other 2353109 BLUE CROSS BLUE SHIELD
Other 4630736 BLUE CROSS BLUE SHIELD
Other 300061402 BLUE CROSS BLUE SHIELD
Other 1642996 BLUE CROSS BLUE SHIELD

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