Healthcare Provider Details

I. General information

NPI: 1063639763
Provider Name (Legal Business Name): RODGER ERNEST FOSTER D.V.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 DARLING ST
SOUTHINGTON CT
06489
US

IV. Provider business mailing address

35 DARLING ST
SOUTHINGTON CT
06489-2654
US

V. Phone/Fax

Practice location:
  • Phone: 860-621-9328
  • Fax: 860-620-6438
Mailing address:
  • Phone: 860-621-9328
  • Fax: 860-620-6438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number1748
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: