Healthcare Provider Details

I. General information

NPI: 1609912070
Provider Name (Legal Business Name): GREGORY ALAN FOSTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 12/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 WEST CARACAS AVENUE SUITE 101
HERSHEY PA
17033
US

IV. Provider business mailing address

205 WEST CARACAS AVENUE SUITE 101
HERSHEY PA
17033
US

V. Phone/Fax

Practice location:
  • Phone: 717-298-6280
  • Fax: 717-298-6283
Mailing address:
  • Phone: 717-298-6280
  • Fax: 717-298-6283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberT - 1892
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD437889
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: