Provider Demographics
NPI:1962505966
Name:FORNADLEY, JOHN A (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:FORNADLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 POPLAR CHURCH RD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-2203
Mailing Address - Country:US
Mailing Address - Phone:717-763-7400
Mailing Address - Fax:717-909-9567
Practice Address - Street 1:875 POPLAR CHURCH RD
Practice Address - Street 2:SUITE 320
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-2203
Practice Address - Country:US
Practice Address - Phone:717-763-7400
Practice Address - Fax:717-909-9567
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD028182E207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1962505966OtherNPI
PA1962505966OtherNPI
PAE75525Medicare UPIN
PA028715Medicare ID - Type Unspecified