Healthcare Provider Details

I. General information

NPI: 1780665984
Provider Name (Legal Business Name): SAMUEL H FOSTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 HOSPITAL RD SUITE 306
PRINCE FREDERICK MD
20678-4044
US

IV. Provider business mailing address

985 PRINCE FREDERICK BLVD STE 201
PRINCE FREDERICK MD
20678-3492
US

V. Phone/Fax

Practice location:
  • Phone: 410-414-6559
  • Fax: 410-414-5332
Mailing address:
  • Phone: 410-535-2005
  • Fax: 410-535-4850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberD0057820
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: