Provider Demographics
NPI:1194716753
Name:FOSTER, JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:FOSTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-643-8000
Mailing Address - Fax:617-643-8122
Practice Address - Street 1:332 HANOVER ST
Practice Address - Street 2:NEHC
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02113-1901
Practice Address - Country:US
Practice Address - Phone:617-643-8000
Practice Address - Fax:617-643-8122
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA58548207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA058548OtherTUFTS HEALTH PLAN
MA2001551Medicaid
MAJ11795OtherBCBS MA
MA058548OtherTUFTS HEALTH PLAN
MA2001551Medicaid