Provider Demographics
NPI:1306183702
Name:FOSTER, TANJA MINOVA (MD)
Entity Type:Individual
Prefix:DR
First Name:TANJA
Middle Name:MINOVA
Last Name:FOSTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1845 PRECINCT LINE RD
Mailing Address - Street 2:STE 209
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76054-3109
Mailing Address - Country:US
Mailing Address - Phone:817-632-5803
Mailing Address - Fax:817-632-5803
Practice Address - Street 1:1845 PRECINCT LINE RD
Practice Address - Street 2:STE 209
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76054-3109
Practice Address - Country:US
Practice Address - Phone:817-321-0937
Practice Address - Fax:469-522-6889
Is Sole Proprietor?:No
Enumeration Date:2013-01-07
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXQ43992085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN321560OtherLOGISTICS HEALTH INC
TN103I309879Medicare PIN
TNQ000988Medicaid
TN103I309878Medicare PIN
TN1183466OtherUSA MCO
TN103I309880Medicare PIN