Provider Demographics
NPI:1669449047
Name:FOSTER, K WADE (MD, PA)
Entity Type:Individual
Prefix:DR
First Name:K
Middle Name:WADE
Last Name:FOSTER
Suffix:
Gender:M
Credentials:MD, PA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2502 SAND MINE RD
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33897-3402
Mailing Address - Country:US
Mailing Address - Phone:855-353-7546
Mailing Address - Fax:863-294-2767
Practice Address - Street 1:2502 SAND MINE RD
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33897-3402
Practice Address - Country:US
Practice Address - Phone:855-353-7546
Practice Address - Fax:863-294-2767
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA98634207ND0101X
PAMD433747207ND0101X
AL26365207ND0101X
FLME 100760207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAKZ87WMedicare PIN
I26229Medicare UPIN