Provider Demographics
NPI:1245294040
Name:FOSTER, MARK (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:FOSTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1323 ROUTE 9
Mailing Address - Street 2:SUITE 204
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-4904
Mailing Address - Country:US
Mailing Address - Phone:845-298-7022
Mailing Address - Fax:845-298-5618
Practice Address - Street 1:1323 ROUTE 9
Practice Address - Street 2:SUITE 204
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-4904
Practice Address - Country:US
Practice Address - Phone:845-298-7022
Practice Address - Fax:845-298-5618
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-17
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174350207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01070057Medicaid
NY4224223OtherAETNA PPO/POS
NY10031814OtherCDPHP
NY267374OtherMVP-PEDIATRIC
NYP396636OtherOXFORD
NY117566OtherMVP-INTERNAL MED
NY0D0761OtherHEALTHNET
NY535003OtherAETNA HMO-INT MEDS
NY3479272OtherAETNA HMO-PEDS
NY10031814OtherCDPHP
NY117566OtherMVP-INTERNAL MED