Provider Demographics
NPI:1649556101
Name:DR KEITH T FOSTER PHD PA
Entity type:Organization
Organization Name:DR KEITH T FOSTER PHD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:239-293-0057
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:239-293-0057
Practice Address - Fax:410-266-5328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-28
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty