Provider Demographics
NPI:1295408987
Name:MESOL, HALEY (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:HALEY
Middle Name:
Last Name:MESOL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:HALEY
Other - Middle Name:
Other - Last Name:BUTRUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:11110 MEDICAL CAMPUS RD
Mailing Address - Street 2:SUITE 147
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-6755
Mailing Address - Country:US
Mailing Address - Phone:301-714-4350
Mailing Address - Fax:301-714-4353
Practice Address - Street 1:11110 MEDICAL CAMPUS RD STE 147
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-6755
Practice Address - Country:US
Practice Address - Phone:301-714-4350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-28
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC08213363A00000X
PAMA062660363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant