Provider Demographics
NPI:1093075418
Name:FOSTER, ALLAINE
Entity Type:Individual
Prefix:
First Name:ALLAINE
Middle Name:
Last Name:FOSTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2602 CEDARWOOD RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9772
Mailing Address - Country:US
Mailing Address - Phone:843-460-0324
Mailing Address - Fax:843-793-1084
Practice Address - Street 1:2602 CEDARWOOD RD
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9772
Practice Address - Country:US
Practice Address - Phone:843-460-0324
Practice Address - Fax:843-793-1084
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-18
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCEA1018Medicaid