Provider Demographics
NPI:1851398135
Name:FOSTER, REBECCA J (PA)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:J
Last Name:FOSTER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:J
Other - Last Name:SPANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:370 LUNENBURG ST
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420-4541
Mailing Address - Country:US
Mailing Address - Phone:978-343-2775
Mailing Address - Fax:978-343-7150
Practice Address - Street 1:100 CHAMBERS ST
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:RI
Practice Address - Zip Code:02864-7724
Practice Address - Country:US
Practice Address - Phone:401-724-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010014363AM0700X
MA2231363A00000X
RIPA01650363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q41188Medicare UPIN