Basic Information
| Provider Information | |||||||||
| NPI: | 1154358703 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FOSTER | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3625 N ELM ST | ||||||||
| Address2: | SUITE 110A | ||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274552604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362824840 | ||||||||
| FaxNumber: | 3362824660 | ||||||||
| Practice Location | |||||||||
| Address1: | 3625 N ELM ST | ||||||||
| Address2: | SUITE 110A | ||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274552604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362824840 | ||||||||
| FaxNumber: | 3362824660 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2006 | ||||||||
| LastUpdateDate: | 03/25/2010 | ||||||||
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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 | 207L00000X | 9300117 | NC | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 1426G | 01 | NC | BCBS | OTHER | 8933294 | 05 | NC | MEDICAID |