1285717231 NPI number — MARSHALL SHANE FOSTER M.D.

Table of content: (NPI 1134184112)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285717231 NPI number — MARSHALL SHANE FOSTER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FOSTER
Provider First Name:
MARSHALL
Provider Middle Name:
SHANE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285717231
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/07/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
377 GALLIMORE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BREVARD
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28712-8874
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-884-9030
Provider Business Mailing Address Fax Number:
828-884-3563

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
377 GALLIMORE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BREVARD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28712-8874
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-884-9030
Provider Business Practice Location Address Fax Number:
828-884-3563
Provider Enumeration Date:
10/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  97-00552 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01-70986 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 0637660001 . This is a "PALMETTO GOV. BENEFITS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 891051X , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 080108995 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: NCM978D . This is a "MEDICARE PTAN" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 1051X . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 561852981G . This is a "CIGNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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