MEDICARE: GARY L ROARK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	252446	MA
2	207L00000X	Anesthesiology Physician	M-2261	GU
3	207LP2900X	Pain Medicine (Anesthesiology) Physician	252446	MA
4	207LP3000X	Pediatric Anesthesiology Physician	252446	MA
5	207L00000X	Anesthesiology Physician	D42992	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922083450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY L ROARK MD

Provider Business Mailing Address
First Line	:	830 TUCK ST
Second Line	:
City	:	LEBANON
State	:	PA
Zip	:	17042-7477
Country	:	US
Telephone Number	:	717-272-4104
Fax Number	:

Provider Business Practice Location Address
First Line	:	830 TUCK ST
Second Line	:
City	:	LEBANON
State	:	PA
Zip	:	17042-7477
Country	:	US
Telephone Number	:	717-272-4104
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/07/2005
Last Update Date	:	04/07/2023

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