Provider Demographics
NPI:1336133388
Name:GUILFOYLE, MICHELE A (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:A
Last Name:GUILFOYLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 BORTHWICK AVE
Mailing Address - Street 2:SUITE 202W
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-4174
Mailing Address - Country:US
Mailing Address - Phone:603-433-8434
Mailing Address - Fax:603-436-6608
Practice Address - Street 1:330 BORTHWICK AVE
Practice Address - Street 2:SUITE 202W
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-4174
Practice Address - Country:US
Practice Address - Phone:603-433-8434
Practice Address - Fax:603-436-6608
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0316P363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3086741Medicaid
NHQX1619Medicare PIN
NH970012498Medicare PIN
NH3086741Medicaid
NH970012498Medicare PIN
NH30333680Medicaid