Healthcare Provider Details

I. General information

NPI: 1437240074
Provider Name (Legal Business Name): ROBERT OROURKE PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 HARRY KEMP WAY
PROVINCEOWN MA
02657
US

IV. Provider business mailing address

PO BOX 1944
NORTH EASTHAM MA
02651
US

V. Phone/Fax

Practice location:
  • Phone: 508-487-9395
  • Fax: 508-487-3285
Mailing address:
  • Phone: 508-240-0208
  • Fax: 508-240-0499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number92
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: