Basic Information
| Provider Information | |||||||||
| NPI: | 1063497352 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FOSTER | ||||||||
| FirstName: | HARRIS | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 208041 | ||||||||
| Address2: | 800 HOWARD AVENUE #318 | ||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065208041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037852815 | ||||||||
| FaxNumber: | 2037854043 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 HOWARD AVENUE #318 | ||||||||
| Address2: | |||||||||
| City: | NEW HAVEN | ||||||||
| State: | CT | ||||||||
| PostalCode: | 065208041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037852815 | ||||||||
| FaxNumber: | 2037854043 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/09/2005 | ||||||||
| LastUpdateDate: | 04/14/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 032347 | CT | Y | Allopathic & Osteopathic Physicians | Urology |
ID Information
| ID | Type | State | Issuer | Description | 001323477 | 05 | CT | MEDICAID |