Provider Demographics
NPI:1730490145
Name:ROBERT W. FOSTER, MD, A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:ROBERT W. FOSTER, MD, A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-461-9600
Mailing Address - Street 1:5565 GROSSMONT CENTER DR. STE 105
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-6102
Mailing Address - Country:US
Mailing Address - Phone:619-461-9600
Mailing Address - Fax:619-461-0334
Practice Address - Street 1:5565 GROSSMONT CENTER DR STE 105
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3021
Practice Address - Country:US
Practice Address - Phone:619-461-9600
Practice Address - Fax:619-461-0334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG56132207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA53089Medicare UPIN