Provider Demographics
NPI:1255323150
Name:FOULKS, DEVON C (MD)
Entity Type:Individual
Prefix:
First Name:DEVON
Middle Name:C
Last Name:FOULKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3550 MAIN ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1089
Mailing Address - Country:US
Mailing Address - Phone:413-781-8290
Mailing Address - Fax:413-732-7628
Practice Address - Street 1:3550 MAIN ST
Practice Address - Street 2:SUITE 302
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1089
Practice Address - Country:US
Practice Address - Phone:413-781-8290
Practice Address - Fax:413-732-7628
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2007-11-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA53245207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6180515Medicaid
MAA57132Medicare UPIN
MA6180515Medicaid