Roger F Crake, MD
Individual provider Active NPI Surgery Physician · Berwick, PA
NPI 1295733418 · NPPES record last updated Dec 10, 2009
Key facts
- NPI
- 1295733418
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Surgery Physician 208600000X
- License
- 022637-E (PA)
- Practice address
- 695 E 16TH St
Suite C
Berwick, PA 18603-2320 - Phone
- (570) 759-3561
- Fax
- (570) 759-0314
- NPI assigned
- Jul 12, 2005
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 022637-E | PA | MD | Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Intermountain Medical Group, Inc | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 022637-E | PA | Yes |
Addresses
Primary practice location
695 E 16TH St
Suite C
Berwick, PA 18603-2320
Mailing address
695 E 16TH St
Suite C
Berwick, PA 18603-2320
Phone (570) 759-3561
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0009046710002 | Medicaid | PA |
Other providers in Berwick, PA
- CHS Berwick Hospital Center
- Joshua James Clark
- Columbia Foot & Ankle Center PC
- Columbia Montour Home Health Services Vna, Inc.
- Comprehensive Vein Care Inc
- Megan Colleen Crawford
- David Curfman
- John E Definnis
- Dental Health Clinic
- Jose Franklin Derr
All providers in Berwick, PA · Surgery Physician in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 10, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.