National Provider Identifier Database

MARK W MEMOLO, MD – NPI #1386627115
Diagnostic Radiology

A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.

Contact Information

MARK W MEMOLO, MD
620 SUMMIT CROSSING PL
STE 106
GASTONIA, NC  28054
Phone: 704-867-8021
Fax: 704-864-4606
Website:
Specialty Taxonomy Code
* Diagnostic Radiology 2085R0202X
Vascular & Interventional Radiology 2085R0204X

* Indicates primary specialty

NPI Profile & details for MARK W MEMOLO

NPI Number 1386627115
Credentials MD
Entity Individual
Enumeration date 11/25/2005
Last updated 08/23/2010 - About 16 years ago
Sole proprietor1 No
Identifiers
  • NC License #: 33274
  • NC Medicaid: 8958609
  • SC Medicaid: N33274
  • Other: 2353109 AETNA HMO
  • Other: 4630736 AETNA PPO
  • Other: 58609 BLUE CROSS BLUE SHIELD
  • Other: 73411 MEDCOST
  • Other: 12402 PARTNERS
  • Other: 300061402 RAILROAD MEDICARE
  • Other: 1642996 UNITED HEALTHCARE
Hospital affiliation n/a

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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