Provider Demographics
NPI:1255596219
Name:FOSTER, DO, LAWRENCE A
Entity type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:A
Last Name:FOSTER, DO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 SOCIETY HILL BLVD
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL BLVD
Mailing Address - State:NJ
Mailing Address - Zip Code:08003
Mailing Address - Country:US
Mailing Address - Phone:609-280-2171
Mailing Address - Fax:
Practice Address - Street 1:1030 SOCIETY HILL BLVD
Practice Address - Street 2:
Practice Address - City:CHERRY HILL BLVD
Practice Address - State:NJ
Practice Address - Zip Code:08003
Practice Address - Country:US
Practice Address - Phone:609-280-2171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-18
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB02305200207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAD90454Medicare UPIN