Provider Demographics
NPI:1376595199
Name:ARIAS, ROQUE MANUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:ROQUE
Middle Name:MANUEL
Last Name:ARIAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EAST BEND
Mailing Address - State:NC
Mailing Address - Zip Code:27018-6900
Mailing Address - Country:US
Mailing Address - Phone:336-699-2973
Mailing Address - Fax:336-699-2974
Practice Address - Street 1:112 E MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST BEND
Practice Address - State:NC
Practice Address - Zip Code:27018-6900
Practice Address - Country:US
Practice Address - Phone:336-699-2973
Practice Address - Fax:336-699-2974
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC32981208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8911707Medicaid
NCD85644Medicare UPIN
NC213017EMedicare ID - Type Unspecified