Provider Demographics
NPI:1174547459
Name:FOSTER, MARK R (PHD, MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:R
Last Name:FOSTER
Suffix:
Gender:M
Credentials:PHD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 FIRST AVE. CHERRY WAY
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15219-1321
Mailing Address - Country:US
Mailing Address - Phone:412-391-5544
Mailing Address - Fax:412-697-1117
Practice Address - Street 1:602 BALDWIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15017-2525
Practice Address - Country:US
Practice Address - Phone:412-414-2490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD023955E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009489250001Medicaid
PA0009489250001Medicaid
PA794390Medicare ID - Type Unspecified
PA1174547459Medicare PIN