Provider Demographics
NPI:1639925688
Name:SWANK, ROARKE MASON TOLLAR (MD)
Entity type:Individual
Prefix:DR
First Name:ROARKE
Middle Name:MASON TOLLAR
Last Name:SWANK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MASON
Other - Middle Name:ROARKE SWANK
Other - Last Name:TOLLAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:550 SOUTH JACKSON STREET, ACB 3RD FLOOR
Mailing Address - Street 2:UNIVERSITY OF LOUISVILLE
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202
Mailing Address - Country:US
Mailing Address - Phone:502-852-5666
Mailing Address - Fax:
Practice Address - Street 1:550 SOUTH JACKSON STREET, ACB 3RD FLOOR
Practice Address - Street 2:UNIVERSITY OF LOUISVILLE
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202
Practice Address - Country:US
Practice Address - Phone:502-852-5666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program