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General NPI Number Information
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NPI Number | 1023324027
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Entity Type | Organization
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Legal Business Name | ROGER L ROARK, MD PA
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Dates
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Enumeration Date | 08/27/2010
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Last Update Date | 08/27/2010
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Provider Practice Location Address
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Address Line | 555 KITCHINGS DR STE C
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City | STATESVILLE
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State | NC
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Zip | 28677-3576
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Country | US
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Telephone | 704-873-2516
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Fax | 704-873-1431
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Provider Business Mailing Address
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Address Line | 555 KITCHINGS DR STE C
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City | STATESVILLE
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State | NC
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Zip | 28677-3576
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Country | US
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Telephone | 704-873-2516
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Fax | 704-873-1431
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Authorized Official
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Title or Position | OWNER
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Name | ROGER LEE ROARK
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Credential | MD
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Telephone | 704-873-2516
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 20190
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License Number State | NC
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