Healthcare Provider Details

I. General information

NPI: 1851377964
Provider Name (Legal Business Name): BETHANY B. FOSTER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BETHANY L BRAMAN

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 03/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

759 CHESTNUT ST
SPRINGFIELD MA
01199-1001
US

IV. Provider business mailing address

280 CHESTNUT ST
SPRINGFIELD MA
01199-1000
US

V. Phone/Fax

Practice location:
  • Phone: 413-794-3233
  • Fax:
Mailing address:
  • Phone: 413-794-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number055
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1771
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: