Provider Demographics
NPI:1972588309
Name:OROURKE, KENNETH STUART (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:STUART
Last Name:OROURKE
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:RHEUMATOLOGY ASSOCIATES, PA
Mailing Address - Street 2:51 SEWALL STREET
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2643
Mailing Address - Country:US
Mailing Address - Phone:207-774-5761
Mailing Address - Fax:207-874-7478
Practice Address - Street 1:RHEUMATOLOGY ASSOCIATES, PA
Practice Address - Street 2:51 SEWALL STREET
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2643
Practice Address - Country:US
Practice Address - Phone:207-774-5761
Practice Address - Fax:207-874-7478
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC35999207R00000X, 207RR0500X
MEMD21645174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC44250OtherMEDCOST
NC64269OtherBCBS
SCQ35999Medicaid
WV2005058000Medicaid
NC4263OtherPARTNERS
VA6014631Medicaid
ME1060000000Medicaid
5826162OtherAETNA
NC8964269Medicaid
F04734Medicare UPIN
NC44250OtherMEDCOST