Provider Demographics
NPI:1811046360
Name:FOSTER, MARK ALLEN (CRNA)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:ALLEN
Last Name:FOSTER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Mailing Address - Street 1:220 PRAY HILL RD
Mailing Address - Street 2:
Mailing Address - City:CHEPACHET
Mailing Address - State:RI
Mailing Address - Zip Code:02814-2503
Mailing Address - Country:US
Mailing Address - Phone:401-729-2485
Mailing Address - Fax:
Practice Address - Street 1:111 BREWSTER ST
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-4400
Practice Address - Country:US
Practice Address - Phone:401-729-2431
Practice Address - Fax:401-729-3476
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRNA22639367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered