Healthcare Provider Details

I. General information

NPI: 1154987949
Provider Name (Legal Business Name): SOPHIA LOFTUS O'ROURKE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2019
Last Update Date: 06/24/2022
Certification Date: 06/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 WESTFALL RD STE E
ROCHESTER NY
14618-2611
US

IV. Provider business mailing address

880 WESTFALL RD STE E
ROCHESTER NY
14618-2611
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-4174
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number317305-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: