Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | MD-041464-L | PA |
NPI | 1003352089 |
---|---|
Provider Name | Dr. Maureen Mccormack O'rourke |
First Address | Wynnewood, PA 19096-3422 |
Second Address | Wynnewood, PA 19096-3422 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2017 |
Last Update Date | 13/01/2017 |