Individual ProviderKenneth Robert DurrwachterFamily MedicineAllopathic & Osteopathic PhysiciansPractice Address1705 Warren Ave, Suite 208, Williamsport, PA 17701-2647(570) 601-6230PECOS EnrollmentBased on the most recent information from CMS, provider Kenneth Robert Durrwachter does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1992702682Provider TypeIndividualFull NameDurrwachter, Kenneth RobertTitleDr.CredentialMDGenderMaleSole ProprietorNoEnumeration Date7/7/2005Last Updated7/27/2021Contact InformationPractice LocationPractice Address1705 Warren Ave, Suite 208, Williamsport, PA 17701-2647Phone(570) 601-6230Fax(570) 601-6232Mailing LocationMailing Address1705 Warren Ave Ste 208, Williamsport, PA 17701-2665Phone(570) 601-6230Fax(570) 601-6232Provider TaxonomiesCodeDescriptionLicenseCode207Q00000XPrimaryDescriptionFamily MedicineAllopathic & Osteopathic PhysiciansLicenseMD045039LPennsylvaniaProvider IdentifiersIDDescriptionIssuerID1147510DescriptionOtherIssuerCIGNAPennsylvaniaID5664476DescriptionOtherIssuerAETNAPennsylvaniaID721386DescriptionOtherIssuerHIGHMARK BLUE SHIELDPennsylvaniaID1279162DescriptionOtherIssuerUNITEDHEALTHCAREPennsylvaniaID7420DescriptionOtherIssuerGEISINGER HEALTH PLANPennsylvaniaID0012837330009DescriptionMedicaidIssuerUnlistedPennsylvaniaID002787DescriptionOtherIssuerFIRST PRIORITY HEALTHPennsylvaniaIDF26620DescriptionOtherIssuerHEALTHAMERICAPennsylvania