Provider Demographics
NPI:1437314895
Name:FORNEY, JOHN POOLE (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:POOLE
Last Name:FORNEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:7 DOCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17842-8910
Mailing Address - Country:US
Mailing Address - Phone:570-837-2123
Mailing Address - Fax:570-837-2185
Practice Address - Street 1:100 S FIRST STREET
Practice Address - Street 2:
Practice Address - City:MILLERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17061-1501
Practice Address - Country:US
Practice Address - Phone:717-692-4834
Practice Address - Fax:717-692-3678
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-25
Last Update Date:2022-04-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD443362207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1026175950008Medicaid
PA1026175950007Medicaid
PA223806F6KMedicare PIN