Basic Information
| Provider Information | |||||||||
| NPI: | 1003817230 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FOSTER | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | W. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 98509 | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708849509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2257692200 | ||||||||
| FaxNumber: | 2257682185 | ||||||||
| Practice Location | |||||||||
| Address1: | 10101 PARK ROWE AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708101685 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2257692200 | ||||||||
| FaxNumber: | 2257682185 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2005 | ||||||||
| LastUpdateDate: | 04/24/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085N0700X | 18484 | TN | N | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085R0202X | 18484 | TN | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085N0700X | 0101032902 | VA | N | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085R0202X | 0101032902 | VA | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | MD.07009R | LA | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085N0700X | MD.07009R | LA | N | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology |
ID Information
| ID | Type | State | Issuer | Description | 10032521 | 01 | VA | SENTARA | OTHER | 227701063 | 01 | CHAMPUS | OTHER | 0216612000 | 05 | WV | MEDICAID | 3058520 | 01 | TN | BCBS | OTHER | 64758959 | 05 | KY | MEDICAID | P00797176 | 01 | LA | MEDICARE, RAILROAD | OTHER | 890508T | 05 | NC | MEDICAID | 202043 | 01 | VA | ANTHEM BCBS | OTHER | 3035792 | 05 | TN | MEDICAID | 300066639 | 01 | PGBA (RR MEDICARE) | OTHER | R07104 | 01 | TN | JOHN DEERE | OTHER | 10032521 | 01 | VA | OPTIMA | OTHER | 1003817230 | 05 | VA | MEDICAID | 7213352 | 05 | VA | MEDICAID |