Provider Demographics
NPI:1023061884
Name:FOSTER, LARRY J (MD)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:J
Last Name:FOSTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 W STONE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-6027
Mailing Address - Country:US
Mailing Address - Phone:423-247-5197
Mailing Address - Fax:423-247-5254
Practice Address - Street 1:111 W STONE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-6027
Practice Address - Country:US
Practice Address - Phone:423-247-5197
Practice Address - Fax:423-247-5254
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13040207RP1001X
VA0101233194207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0014583OtherBLUE CROSS BLUE SHIELD
VA006004229OtherVIRGINIA MEDICAID
VA055802OtherANTHEM
TN5464032OtherAETNA
TN100024258OtherPHP TENN CARE
TN1000908Medicaid
TN62134825603OtherJOHN DEERE HEALTHCARE
KY64749120OtherKENTUCKY MEDICAID
TNZ101OtherUNITED HEALTHCARE OF THE RIVER VALLEY
TN3184714Medicaid
TN39708OtherUNITED HEALTHCARE
TN103I292952Medicare PIN
TN103G477120Medicare PIN
VA016860P50Medicare PIN
TNZ101OtherUNITED HEALTHCARE OF THE RIVER VALLEY
TN1000908Medicaid
GAP00195517Medicare PIN
VA006004229OtherVIRGINIA MEDICAID
TN5464032OtherAETNA
TN3184714Medicare PIN
VA055802OtherANTHEM
TN3184714Medicaid
TN0014583OtherBLUE CROSS BLUE SHIELD
VAV V3866BMedicare PIN
TN3700107Medicare PIN