Individual
MS. FAYE MEMOLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
187 MAIN ST, APT. 6, COLEBROOK, NH 03576-2012
(603) 348-0259
Mailing address
187 MAIN ST., APT. 6, NATIONAL DERMATOLOGY HEALTHCARE/FAYE MEMOLO, PA-C, COLEBROOK, NH 03576
(603) 348-0259
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0403 P
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00068486
BCBS OF VT
VT
01
—
200999212
TAX ID
NH
05
—
30333351
—
NH
01
—
7058699
AETNA
NH
05
—
9000213
—
VT
Enumeration date
05/08/2006
Last updated
07/14/2011
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