Provider Demographics
NPI:1285717231
Name:FOSTER, MARSHALL SHANE (MD)
Entity type:Individual
Prefix:
First Name:MARSHALL
Middle Name:SHANE
Last Name:FOSTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:377 GALLIMORE RD
Mailing Address - Street 2:
Mailing Address - City:BREVARD
Mailing Address - State:NC
Mailing Address - Zip Code:28712-8874
Mailing Address - Country:US
Mailing Address - Phone:828-884-9030
Mailing Address - Fax:828-884-3563
Practice Address - Street 1:377 GALLIMORE RD
Practice Address - Street 2:
Practice Address - City:BREVARD
Practice Address - State:NC
Practice Address - Zip Code:28712-8874
Practice Address - Country:US
Practice Address - Phone:828-884-9030
Practice Address - Fax:828-884-3563
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC97-00552207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC01-70986OtherUNITED HEALTHCARE
NC0637660001OtherPALMETTO GOV. BENEFITS
NC891051XMedicaid
NC080108995OtherRAILROAD MEDICARE
NCNCM978DOtherMEDICARE PTAN
NC1051XOtherBLUE CROSS BLUE SHIELD
NC561852981GOtherCIGNA
NCG52056Medicare UPIN