Individual
GARY L ROARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
830 TUCK ST, LEBANON, PA 17042-7477
(717) 272-4104
Mailing address
830 TUCK ST, LEBANON, PA 17042-7477
(717) 272-4104
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
252446
MA
207L00000X
Anesthesiology Physician
Primary
D42992
MD
207L00000X
Anesthesiology Physician
M-2261
GU
207LP2900X
Pain Medicine (Anesthesiology) Physician
252446
MA
207LP3000X
Pediatric Anesthesiology Physician
252446
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110093673A
—
MA
Enumeration date
12/07/2005
Last updated
04/07/2023
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