Provider Demographics
NPI:1912720418
Name:FOSTER, MADISON SUZANNE (PA-C)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:SUZANNE
Last Name:FOSTER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:PA
Mailing Address - Zip Code:15009-2530
Mailing Address - Country:US
Mailing Address - Phone:724-770-7976
Mailing Address - Fax:
Practice Address - Street 1:1211 3RD ST
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-2530
Practice Address - Country:US
Practice Address - Phone:724-770-7976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-04
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA066205363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant