Healthcare Provider Details

I. General information

NPI: 1740282979
Provider Name (Legal Business Name): CORA LEE FOSTER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 TRUMANSBURG RD STE E
ITHACA NY
14850-1397
US

IV. Provider business mailing address

312 EASTWOOD AVE
ITHACA NY
14850-6202
US

V. Phone/Fax

Practice location:
  • Phone: 607-273-3161
  • Fax: 607-273-4979
Mailing address:
  • Phone: 607-273-3161
  • Fax: 607-273-4979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number203744
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: