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Contact Information

MARK W MEMOLO, MD
620 SUMMIT CROSSING PL
STE 106
GASTONIA, NC28054
 Phone: 704-867-8021
 Fax: 704-864-4606
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Diagnostic Radiology

2085R0202X 30 Physician/Diagnostic Radiology
 

Vascular & Interventional Radiology

2085R0204X 94 Physician/Interventional Radiology
Indicates primary specialty

NPI Profile & details for MARK W MEMOLO · (Male)

NPI Number 1386627115
Status Active
Credentials MD
Entity Individual
Enumeration date 11/25/2005
Last updated 08/23/2010 - About 16 years ago
Sole proprietor 1 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(s)
  • GASTON MEMORIAL HOSPITAL - (Acute Care)
    2525 COURT DR
    GASTONIA, NC 28052
  • PIEDMONT MEDICAL CENTER - (Acute Care)
    222 S HERLONG AVE
    ROCK HILL, SC 29730
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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