Basic Information
| Provider Information | |||||||||
| NPI: | 1073540464 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | O'ROURKE | ||||||||
| FirstName: | BRIDGET | ||||||||
| MiddleName: | ANNE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 HOT METAL ST | ||||||||
| Address2: | QUANTUM ONE, SUITE 001 | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152032348 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4126473087 | ||||||||
| FaxNumber: | 7249358376 | ||||||||
| Practice Location | |||||||||
| Address1: | 2400 CORPORATE DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | WEXFORD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 150907645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7249354700 | ||||||||
| FaxNumber: | 7249358376 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2006 | ||||||||
| LastUpdateDate: | 01/27/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | C10007360 | DE | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MD422569 | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1018691950001 | 05 | PA | MEDICAID | 1944752 | 01 | PA | HIGHMARK | OTHER |