Provider Demographics
NPI:1598901464
Name:FOSTER, CARLA ELIZABETH (PA)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:ELIZABETH
Last Name:FOSTER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4615 HUNTRIDGE RD.
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24012
Mailing Address - Country:US
Mailing Address - Phone:540-977-0900
Mailing Address - Fax:540-977-0550
Practice Address - Street 1:4615 HUNTRIDGE RD
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24012-8510
Practice Address - Country:US
Practice Address - Phone:540-977-0900
Practice Address - Fax:540-977-0550
Is Sole Proprietor?:No
Enumeration Date:2008-12-26
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110002935363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1598901464Medicaid
VAMC12717Medicare PIN
VA1598901464Medicaid