Provider Demographics
NPI:1962476796
Name:FOSTER, JOHN WATKINS JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WATKINS
Last Name:FOSTER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:116 GRANITE ST
Mailing Address - Street 2:
Mailing Address - City:WESTERLY
Mailing Address - State:RI
Mailing Address - Zip Code:02891-2460
Mailing Address - Country:US
Mailing Address - Phone:401-596-5695
Mailing Address - Fax:401-596-0170
Practice Address - Street 1:116 GRANITE ST
Practice Address - Street 2:
Practice Address - City:WESTERLY
Practice Address - State:RI
Practice Address - Zip Code:02891-2460
Practice Address - Country:US
Practice Address - Phone:401-596-5695
Practice Address - Fax:401-596-0170
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD053272085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7001816Medicaid
RI7001816Medicaid