Provider Demographics
NPI:1396728960
Name:FOSTER, KEITH THOMAS (PHD)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:THOMAS
Last Name:FOSTER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 OLD SOLOMONS ISLAND RD STE 200
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3864
Mailing Address - Country:US
Mailing Address - Phone:239-293-0057
Mailing Address - Fax:410-266-5328
Practice Address - Street 1:49 OLD SOLOMONS ISLAND RD STE 200
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3864
Practice Address - Country:US
Practice Address - Phone:410-266-8555
Practice Address - Fax:410-266-5328
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-28
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01221103T00000X
MD1221103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE5867Medicare ID - Type UnspecifiedMEDICARE PAYEE NUMBER