Provider Demographics
NPI:1790739639
Name:O ROURKE, DAVID BRIAN (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:BRIAN
Last Name:O ROURKE
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 1:560 VAN REED RD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-1799
Mailing Address - Country:US
Mailing Address - Phone:610-376-7878
Mailing Address - Fax:610-376-7877
Practice Address - Street 1:560 VAN REED RD
Practice Address - Street 2:SUITE 306
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1799
Practice Address - Country:US
Practice Address - Phone:610-376-7878
Practice Address - Fax:610-376-7877
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039746L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0127756OtherHIGHMARK BLUE SHIELD
PA41540OtherHEALTH AMER HEALTH ASSUR
PA02382200OtherCAPITAL BLUE CROSS
PAB37466Medicare UPIN
PA127756Medicare ID - Type Unspecified