1629014964 NPI number — LISA FOSTER M.D.

Table of content: LISA FOSTER M.D. (NPI 1629014964)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629014964 NPI number — LISA FOSTER M.D.

Organization/Personal Information

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

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MARTINEZ
Provider Other First Name:
LISA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1629014964
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/17/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
205 WEST CARACAS AVENUE
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
HERSHEY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17033
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-298-6280
Provider Business Mailing Address Fax Number:
717-298-6283

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
205 WEST CARACAS AVENUE
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
HERSHEY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-298-6280
Provider Business Practice Location Address Fax Number:
717-298-6283
Provider Enumeration Date:
06/22/2006

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: 2084P0800X , with the licence number:  MD074182L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: FO1310657 . This is a "PA BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: P00057412 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 295653 . This is a "MAMSI" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 01860016 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2102580 . This is a "CIGNA BEHAVIORAL HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 611565 . This is a "BC/BS OF MD CARE FIRST" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 455634 . This is a "VALUE OPTIONS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 02257201 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 274011000 . This is a "MAGELLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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