Provider Demographics
NPI:1427453117
Name:FOSTER, MATTHEW
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:FOSTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4110 KIRBY AVE
Mailing Address - Street 2:
Mailing Address - City:CINCI
Mailing Address - State:OH
Mailing Address - Zip Code:45223
Mailing Address - Country:US
Mailing Address - Phone:513-873-1911
Mailing Address - Fax:
Practice Address - Street 1:4110 KIRBY AVE
Practice Address - Street 2:
Practice Address - City:CINCI
Practice Address - State:OH
Practice Address - Zip Code:45223-2223
Practice Address - Country:US
Practice Address - Phone:513-873-1911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH401111010710OtherDEPARTMENT OF HEALTH
OH0100622Medicaid
OH05110014474OtherFIRST AID AND CPR AED