Provider Demographics
NPI:1104818533
Name:FOSTER, JOHN EDWARD (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:EDWARD
Last Name:FOSTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:111 FOUNDERS PLZ
Mailing Address - Street 2:STE 400
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-3212
Mailing Address - Country:US
Mailing Address - Phone:860-289-3375
Mailing Address - Fax:860-783-5733
Practice Address - Street 1:85 SEYMOUR ST
Practice Address - Street 2:STE 200
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-5501
Practice Address - Country:US
Practice Address - Phone:860-289-3375
Practice Address - Fax:860-560-2849
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2018-01-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA537882085R0204X
CT0397972085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001397977Medicaid
CT010039797CT02OtherANTHEM BC BS
CT010039797CT02OtherANTHEM BC BS
CT001397977Medicaid