MEDICARE: MARK D FOSTER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	00033658	NC
2	207X00000X	Orthopaedic Surgery Physician	11847	SC

General Provider Information

NPI Number	:	1609876788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK D FOSTER MD

Provider Business Mailing Address
First Line	:	902 N HOWE ST
Second Line	:
City	:	SOUTHPORT
State	:	NC
Zip	:	28461-3038
Country	:	US
Telephone Number	:	910-457-4789
Fax Number	:	910-457-5824

Provider Business Practice Location Address
First Line	:	902 N HOWE ST
Second Line	:
City	:	SOUTHPORT
State	:	NC
Zip	:	28461-3038
Country	:	US
Telephone Number	:	910-457-4789
Fax Number	:	910-457-5824

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	10/08/2014

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Directions to “ MARK D FOSTER MD” Practice Location

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