Healthcare Provider Details

I. General information

NPI: 1629878723
Provider Name (Legal Business Name): MELISSA FOSTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2025
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 CALHOUN ST
CHARLESTON SC
29401-1113
US

IV. Provider business mailing address

8378 LONGRIDGE RD
NORTH CHARLESTON SC
29418-2711
US

V. Phone/Fax

Practice location:
  • Phone: 843-724-2010
  • Fax:
Mailing address:
  • Phone: 843-860-9652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: