Provider Demographics
NPI:1063497352
Name:FOSTER, HARRIS E JR (MD)
Entity Type:Individual
Prefix:
First Name:HARRIS
Middle Name:E
Last Name:FOSTER
Suffix:JR
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:PO BOX 208041
Mailing Address - Street 2:800 HOWARD AVENUE #318
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06520-8041
Mailing Address - Country:US
Mailing Address - Phone:203-785-2815
Mailing Address - Fax:203-785-4043
Practice Address - Street 1:800 HOWARD AVENUE #318
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06520-8041
Practice Address - Country:US
Practice Address - Phone:203-785-2815
Practice Address - Fax:203-785-4043
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-09
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT032347208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001323477Medicaid
CT340000212Medicare ID - Type Unspecified
F32694Medicare UPIN