Brandon Kenneth Fornwalt, MD, PHD

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

MD467471 Issued in PA

Practice address

100 N Academy Ave
Danville, PA 17822-5724

Phone

(570) 271-6301

Fax

(570) 271-5976

NPI assigned

Apr 2, 2010

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine, Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1270166400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1562284800000",
    "number": "1811212707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 N ACADEMY AVE",
            "city": "DANVILLE",
            "state": "PA",
            "postal_code": "178224903",
            "telephone_number": "570-271-6144",
            "fax_number": "570-271-6578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 N ACADEMY AVE",
            "city": "DANVILLE",
            "state": "PA",
            "postal_code": "178225724",
            "telephone_number": "570-271-6301",
            "fax_number": "570-271-5976"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORNWALT",
        "first_name": "BRANDON",
        "middle_name": "KENNETH",
        "name_prefix": "Dr.",
        "credential": "MD, PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-04-02",
        "last_updated": "2019-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "PA",
            "license": "MD467471",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael A. Foltzer, M.D.
• Jenny Foote, LSW
• Mitchell Forgash, RDN, LDN
• Anthony Forman, RN
• Kailyn Forman, CRNA
• Sheri L. Fornwalt, CRNP
• Madison Grace Forren, ATC
• Beverlee Tyler Forster, OTRL
• John Stephen Foster, PT
• Robert Frankel, MD

• Diagnostic Radiology Physician in Danville, PA
• Providers in Danville, PA by specialty
• Diagnostic Radiology Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.