Provider Demographics
NPI:1740216910
Name:O'ROARK, DANIEL M (DO)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:M
Last Name:O'ROARK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 N STATE OF FRANKLIN RD
Mailing Address - Street 2:STE 2
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-3645
Mailing Address - Country:US
Mailing Address - Phone:423-926-4468
Mailing Address - Fax:423-928-4838
Practice Address - Street 1:701 N STATE OF FRANKLIN RD
Practice Address - Street 2:STE 9
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-3645
Practice Address - Country:US
Practice Address - Phone:423-926-4468
Practice Address - Fax:423-928-4838
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1720174400000X, 207RC0000X
VA0102201788207RC0000X
PAOS006046E207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64108509Medicaid
VA1740216910Medicaid
TN3319525Medicaid
TN621112685OtherUNITED HEALTHCARE
TN3319525Medicare PIN
TN621112685OtherUNITED HEALTHCARE
TN621112685OtherUNITED HEALTHCARE
TNE65175Medicare UPIN