Provider Demographics
NPI:1295045227
Name:ROBERT M FOSTER, MD, PA
Entity Type:Organization
Organization Name:ROBERT M FOSTER, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-599-1131
Mailing Address - Street 1:PO BOX 131
Mailing Address - Street 2:
Mailing Address - City:ROXBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27573-0131
Mailing Address - Country:US
Mailing Address - Phone:336-599-1131
Mailing Address - Fax:336-599-6596
Practice Address - Street 1:503 RIDGE RD
Practice Address - Street 2:
Practice Address - City:ROXBORO
Practice Address - State:NC
Practice Address - Zip Code:27573-4627
Practice Address - Country:US
Practice Address - Phone:336-599-1131
Practice Address - Fax:336-599-6596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-08
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26821207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8933315Medicaid
NC33315OtherBLUE CROSS
NC8933315Medicaid
NC206371AMedicare PIN