Provider Demographics
NPI:1679342844
Name:FOSTER, STEPHEN CHRISTOPHER (CRANIAL PROSTHESIS S)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:CHRISTOPHER
Last Name:FOSTER
Suffix:
Gender:M
Credentials:CRANIAL PROSTHESIS S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10560 MAIN ST STE 215
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-7176
Mailing Address - Country:US
Mailing Address - Phone:703-352-4247
Mailing Address - Fax:
Practice Address - Street 1:10560 MAIN ST STE 215
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-7176
Practice Address - Country:US
Practice Address - Phone:703-352-4247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-28
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier