Provider Demographics
NPI:1962795591
Name:FOSTER, RYAN STERLING (MD)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:STERLING
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 1:1250 W NATIONAL RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ENGLEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45315-9505
Mailing Address - Country:US
Mailing Address - Phone:937-836-6000
Mailing Address - Fax:937-832-4805
Practice Address - Street 1:1250 W NATIONAL RD
Practice Address - Street 2:SUITE 400
Practice Address - City:ENGLEWOOD
Practice Address - State:OH
Practice Address - Zip Code:45315-9505
Practice Address - Country:US
Practice Address - Phone:937-836-2424
Practice Address - Fax:937-832-4805
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-16
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.122741207Q00000X
OH99999207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0125243Medicaid
OH0125243Medicaid