MEDICARE: MONICA MARIE FOSTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian
2	363A00000X	Physician Assistant	MA066668	PA

General Provider Information

NPI Number	:	1740084508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONICA MARIE FOSTER

Provider Business Mailing Address
First Line	:	6060 RIDGE AVE STE 100
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19128-1659
Country	:	US
Telephone Number	:	215-999-6060
Fax Number	:

Provider Business Practice Location Address
First Line	:	6060 RIDGE AVE STE 100
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19128-1659
Country	:	US
Telephone Number	:	850-420-5991
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2025
Last Update Date	:	08/26/2025

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