Provider Demographics
NPI:1003812892
Name:O'ROURKE, JERROLD THOMAS JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JERROLD
Middle Name:THOMAS
Last Name:O'ROURKE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1330 NEW HAMPSHIRE AVE NW
Mailing Address - Street 2:STE 113
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-6300
Mailing Address - Country:US
Mailing Address - Phone:202-463-6634
Mailing Address - Fax:202-463-6638
Practice Address - Street 1:1330 NEW HAMPSHIRE AVE NW
Practice Address - Street 2:STE 113
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-6300
Practice Address - Country:US
Practice Address - Phone:202-463-6634
Practice Address - Fax:202-463-6638
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-26
Last Update Date:2016-12-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
DC172382084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR567017Medicare ID - Type Unspecified