1992702682 NPI number — DR. KENNETH ROBERT DURRWACHTER MD

Table of content: BRIAN J. WHIPPLE LCSW (NPI 1154359651)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992702682 NPI number — DR. KENNETH ROBERT DURRWACHTER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DURRWACHTER
Provider First Name:
KENNETH
Provider Middle Name:
ROBERT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992702682
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/27/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1705 WARREN AVE STE 208
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILLIAMSPORT
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17701-2665
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-601-6230
Provider Business Mailing Address Fax Number:
570-601-6232

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1705 WARREN AVE
Provider Second Line Business Practice Location Address:
SUITE 208
Provider Business Practice Location Address City Name:
WILLIAMSPORT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17701-2647
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-601-6230
Provider Business Practice Location Address Fax Number:
570-601-6232
Provider Enumeration Date:
07/07/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  MD045039L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1147510 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 5664476 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 721386 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1279162 . This is a "UNITEDHEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 7420 . This is a "GEISINGER HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0012837330009 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 002787 . This is a "FIRST PRIORITY HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: F26620 . This is a "HEALTHAMERICA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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