Individual ProviderBrandon Kenneth FornwaltRadiologyAllopathic & Osteopathic PhysiciansPractice Address100 N Academy Ave, Danville, PA 17822-5724(570) 271-6301(570) 271-6144PECOS EnrollmentBased on the most recent information from CMS, provider Brandon Kenneth Fornwalt 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 33 days ago.Profile DetailsProvider ID1811212707Provider TypeIndividualFull NameFornwalt, Brandon KennethTitleDr.CredentialMD, PHDGenderMaleSole ProprietorNoEnumeration Date4/2/2010Last Updated7/5/2019Contact InformationPractice LocationPractice Address100 N Academy Ave, Danville, PA 17822-5724Phone(570) 271-6301Fax(570) 271-5976Mailing LocationMailing Address100 N Academy Ave, Danville, PA 17822-4903Phone(570) 271-6144Fax(570) 271-6578Provider TaxonomiesCodeDescriptionLicenseCode2085R0202XPrimaryDescriptionRadiologyAllopathic & Osteopathic PhysiciansLicenseMD467471PennsylvaniaCode390200000XDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicenseUnlisted Issuer