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NPI Code Detail

MEDICARE: CAROL ROARK MD

MEDICARE: CAROL 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
1208000000XPediatrics Physician22479KY

Other Identifiers

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

General Provider Information

NPI Number : 1669471058
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAROL ROARK MD
Provider Business Mailing Address
First Line : 215 E 11TH ST
Second Line :
City : NEWPORT
State : KY
Zip : 41071-2203
Country : US
Telephone Number : 859-655-6100
Fax Number :
Provider Business Practice Location Address
First Line : 215 E 11TH ST
Second Line :
City : NEWPORT
State : KY
Zip : 41071-2203
Country : US
Telephone Number : 859-655-6100
Fax Number : 859-655-6186
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2005
Last Update Date : 03/15/2021

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Directions to “ CAROL ROARK MD” Practice Location

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