Active NPI
Faye Memolo, PA-C
- Physician Assistant
- Colebrook, NH
National Provider Identifier
1548219728
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 0403 P
- Practice address
- 187 Main St
Apt. 6
Colebrook, NH 03576-2012 - Phone
- (603) 348-0259
- NPI assigned
- May 8, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 0403 P | NH | Primary |
Addresses
Primary practice location
187 Main St
Apt. 6
Colebrook, NH 03576-2012
Mailing address
187 Main St., Apt. 6
National Dermatology Healthcare/Faye Memolo, PA-C
Colebrook, NH 03576
Phone (603) 348-0259
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200999212 | Other | NH | TAX ID |
| 7058699 | Other | NH | AETNA |
| 00068486 | Other | VT | BCBS OF VT |
| 30333351 | Medicaid | NH | |
| 9000213 | Medicaid | VT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6677 | GA | MD | Low Vision Rehabilitation Optometrist |
| 2078 | OK | MD | Family Medicine Physician |
| 0403 | NH | MD | Speech-Language Pathologist |
| 0403 P | NH | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147046400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1310601600000",
"number": "1548219728",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "187 MAIN ST., APT. 6",
"address_2": "NATIONAL DERMATOLOGY HEALTHCARE/FAYE MEMOLO, PA-C",
"city": "COLEBROOK",
"state": "NH",
"postal_code": "03576",
"telephone_number": "603-348-0259"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "187 MAIN ST",
"address_2": "APT. 6",
"city": "COLEBROOK",
"state": "NH",
"postal_code": "035762012",
"telephone_number": "603-348-0259"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEMOLO",
"first_name": "FAYE",
"name_prefix": "Ms.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-08",
"last_updated": "2011-07-14",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NH",
"license": "0403 P",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX ID",
"identifier": "200999212",
"state": "NH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "7058699",
"state": "NH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF VT",
"identifier": "00068486",
"state": "VT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "30333351",
"state": "NH"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "9000213",
"state": "VT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Colebrook, NH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.