Provider Demographics
NPI:1548228505
Name:O'ROURKE, JO-ANN (MD)
Entity Type:Individual
Prefix:
First Name:JO-ANN
Middle Name:
Last Name:O'ROURKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 N 6TH ST
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19601-3096
Mailing Address - Country:US
Mailing Address - Phone:800-409-8771
Mailing Address - Fax:610-208-4718
Practice Address - Street 1:145 N 6TH ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19601-3096
Practice Address - Country:US
Practice Address - Phone:800-409-8771
Practice Address - Fax:610-208-4718
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD029383E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001884742Medicaid
PA001884742Medicaid
PA127757Medicare ID - Type Unspecified