Provider Demographics
NPI:1720014632
Name:FOSTER, CARL J (MD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:J
Last Name:FOSTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4135 BOARDMAN CANFIELD RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-9803
Mailing Address - Country:US
Mailing Address - Phone:330-286-5330
Mailing Address - Fax:330-286-5396
Practice Address - Street 1:200 E. STATE STREET
Practice Address - Street 2:
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-4936
Practice Address - Country:US
Practice Address - Phone:330-596-6000
Practice Address - Fax:330-596-7214
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35073876207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
050091229OtherMEDICARE RAILROAD
000000251381OtherANTHEM
000000251381OtherANTHEM
OH0838392Medicare PIN