Provider Demographics
NPI:1457357857
Name:ROKE, ALBERT D (MD)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:D
Last Name:ROKE
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 1:1137 W PENN AVE
Mailing Address - Street 2:
Mailing Address - City:WOMELSDORF
Mailing Address - State:PA
Mailing Address - Zip Code:19567-9770
Mailing Address - Country:US
Mailing Address - Phone:610-589-2555
Mailing Address - Fax:610-589-4940
Practice Address - Street 1:1137 W PENN AVE
Practice Address - Street 2:
Practice Address - City:WOMELSDORF
Practice Address - State:PA
Practice Address - Zip Code:19567-9770
Practice Address - Country:US
Practice Address - Phone:610-589-2555
Practice Address - Fax:610-589-4940
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD015708E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RO166123OtherBLUE SHIELD
01677801OtherCAPITAL BLUE CROSS
PA0009142930003Medicaid
PA0009142930003Medicaid
RO166123Medicare ID - Type Unspecified