Provider Demographics
NPI:1063430189
Name:WOERTHWEIN, KENNETH FRED (MD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:FRED
Last Name:WOERTHWEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1803 MOUNT ROSE AVE
Mailing Address - Street 2:SUITE B3
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-3026
Mailing Address - Country:US
Mailing Address - Phone:717-851-1405
Mailing Address - Fax:717-851-6969
Practice Address - Street 1:1575 BANNISTER ST
Practice Address - Street 2:SUITE 1
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17404-4946
Practice Address - Country:US
Practice Address - Phone:717-812-2000
Practice Address - Fax:717-812-2010
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD012836E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP002819OtherGATEWAY-WMG
PA234118OtherMAMSI-WMG
PA30042OtherJOHNS HOPKINS
PA4265297OtherAETNA
PA1142412OtherAMERIHEALTH MERCY-WMG
PA81048OtherUNISON-WMG
MD542980OtherCAREFIRST MD BCBS
PA43185OtherGEISINGER
PA01450202OtherCAPITAL BLUE CROSS-WMG
PA000664038Medicaid
PA046628OtherHIGHMARK BLUE SHIELD
PA234118OtherMAMSI-WMG
MD542980OtherCAREFIRST MD BCBS
PA4265297OtherAETNA