MEDICARE: ROGER F CRAKE 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	208600000X	Surgery Physician	022637-E	PA

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	:	1295733418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROGER F CRAKE MD

Provider Business Mailing Address
First Line	:	695 E 16TH ST
Second Line	:	SUITE C
City	:	BERWICK
State	:	PA
Zip	:	18603-2320
Country	:	US
Telephone Number	:	570-759-3561
Fax Number	:	570-759-0314

Provider Business Practice Location Address
First Line	:	695 E 16TH ST
Second Line	:	SUITE C
City	:	BERWICK
State	:	PA
Zip	:	18603-2320
Country	:	US
Telephone Number	:	570-759-3561
Fax Number	:	570-759-0314

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

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	12/10/2009

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Directions to “ ROGER F CRAKE MD” Practice Location

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