Provider Demographics
NPI:1841284247
Name:FORTNEY, JOHN L (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:L
Last Name:FORTNEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:272 HOSPITAL RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-9031
Mailing Address - Country:US
Mailing Address - Phone:740-779-8556
Mailing Address - Fax:740-779-7477
Practice Address - Street 1:4439 STATE ROUTE 159
Practice Address - Street 2:STE G10
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-8207
Practice Address - Country:US
Practice Address - Phone:740-779-4300
Practice Address - Fax:740-779-4390
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2012-06-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH350469952080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0502914Medicaid
OH0502914Medicaid