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NPI Code Detail

MEDICARE: KRYSTOL JOHNSTON O'ROURKE M.D.

MEDICARE: KRYSTOL JOHNSTON O'ROURKE M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician0098-00925NC
2207Q00000XFamily Medicine Physician332287NY

General Provider Information

NPI Number : 1811975287
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRYSTOL JOHNSTON O'ROURKE M.D.
Provider Business Mailing Address
First Line : 100 KINGS HWY S
Second Line :
City : ROCHESTER
State : NY
Zip : 14617-5504
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4302 GATEWAY DR
Second Line :
City : GENESEO
State : NY
Zip : 14454-9449
Country : US
Telephone Number : 585-295-6760
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/05/2006
Last Update Date : 01/10/2025

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