Provider Demographics
NPI:1811975287
Name:O'ROURKE, KRYSTOL JOHNSTON (MD)
Entity type:Individual
Prefix:
First Name:KRYSTOL
Middle Name:JOHNSTON
Last Name:O'ROURKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KRYSTOL
Other - Middle Name:LYNN
Other - Last Name:JOHNSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:100 KINGS HWY S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-5504
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4302 GATEWAY DR
Practice Address - Street 2:
Practice Address - City:GENESEO
Practice Address - State:NY
Practice Address - Zip Code:14454-9449
Practice Address - Country:US
Practice Address - Phone:585-295-6760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0098-00925207Q00000X
NY332287207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCH27852Medicare UPIN
NC2281566BMedicare ID - Type Unspecified