Provider Demographics
NPI:1285617530
Name:FOSTER, CHARLES STEPHEN (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:STEPHEN
Last Name:FOSTER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1440 MAIN STREET
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451
Mailing Address - Country:US
Mailing Address - Phone:781-891-6377
Mailing Address - Fax:617-494-1430
Practice Address - Street 1:1440 MAIN STREET
Practice Address - Street 2:SUITE 201
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451
Practice Address - Country:US
Practice Address - Phone:781-891-6377
Practice Address - Fax:617-494-1430
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-21
Last Update Date:2015-05-08
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Provider Licenses
StateLicense IDTaxonomies
MA37755207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2030667Medicaid
MA703385OtherTUFTS HEALTH PLAN
MAM08846OtherBCBS MA
MA703385OtherTUFTS HEALTH PLAN
D08853Medicare UPIN