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General NPI Number Information
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NPI Number | 1427358175
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Entity Type | Organization
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Legal Business Name | ROARK LLC
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Dates
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Enumeration Date | 10/28/2010
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Last Update Date | 10/28/2010
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Provider Practice Location Address
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Address Line | 2310 RHODE ISLAND AVE NE
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City | WASHINGTON
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State | DC
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Zip | 20018-2829
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Country | US
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Telephone | 202-529-4404
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Fax |
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Provider Business Mailing Address
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Address Line | 2310 RHODE ISLAND AVE
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City | WASHINGTON
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State | DC
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Zip | 20018
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Country | US
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Telephone | 202-529-4404
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Fax |
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Authorized Official
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Title or Position | MEMBER OF LLC
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Name | MR. JOSEPH ANTHONY SUFCZYNSKI JR.
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Credential |
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Telephone | 202-529-4404
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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