Provider Demographics
NPI:1245268143
Name:FOSTER, ROSLYN HAYES (MD)
Entity type:Individual
Prefix:
First Name:ROSLYN
Middle Name:HAYES
Last Name:FOSTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ROSLYN
Other - Middle Name:HAYES
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1 INDEPENDENCE PT STE 212
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4536
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3551A RUTHERFORD RD
Practice Address - Street 2:
Practice Address - City:TAYLORS
Practice Address - State:SC
Practice Address - Zip Code:29687-2195
Practice Address - Country:US
Practice Address - Phone:864-522-4750
Practice Address - Fax:864-522-4755
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18336207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2463Medicaid
SCG45884Medicare UPIN
SCGP2463Medicaid
G45884Medicare UPIN