Provider Demographics
NPI:1841237005
Name:FOSTER, CARLA SUE (MD)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:SUE
Last Name:FOSTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:SUE
Other - Last Name:CHARBONNEAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1000
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-1000
Mailing Address - Country:US
Mailing Address - Phone:801-542-8222
Mailing Address - Fax:801-542-8227
Practice Address - Street 1:1126 E 12300 S
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-9095
Practice Address - Country:US
Practice Address - Phone:801-545-0600
Practice Address - Fax:801-542-0626
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT360883-1205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTG37889Medicare UPIN
UT005819601Medicare ID - Type Unspecified