Provider Demographics
NPI:1154368751
Name:FOSTER, CHARLIE H JR (MD)
Entity type:Individual
Prefix:
First Name:CHARLIE
Middle Name:H
Last Name:FOSTER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:600 NEW WAVERLY PL
Mailing Address - Street 2:STE 203
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-7404
Mailing Address - Country:US
Mailing Address - Phone:919-859-5650
Mailing Address - Fax:919-859-5695
Practice Address - Street 1:600 NEW WAVERLY PL
Practice Address - Street 2:STE 203
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-7404
Practice Address - Country:US
Practice Address - Phone:919-859-5650
Practice Address - Fax:919-859-5695
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2000-01376207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC128AHOtherBCBS
NC89128AHMedicaid
G88493Medicare UPIN
NC2289403AMedicare ID - Type Unspecified