Basic Information
| Provider Information | |||||||||
| NPI: | 1285717231 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FOSTER | ||||||||
| FirstName: | MARSHALL | ||||||||
| MiddleName: | SHANE | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 377 GALLIMORE RD | ||||||||
| Address2: | |||||||||
| City: | BREVARD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287128874 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8288849030 | ||||||||
| FaxNumber: | 8288843563 | ||||||||
| Practice Location | |||||||||
| Address1: | 377 GALLIMORE RD | ||||||||
| Address2: | |||||||||
| City: | BREVARD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287128874 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8288849030 | ||||||||
| FaxNumber: | 8288843563 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2006 | ||||||||
| LastUpdateDate: | 01/07/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 97-00552 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 01-70986 | 01 | NC | UNITED HEALTHCARE | OTHER | 0637660001 | 01 | NC | PALMETTO GOV. BENEFITS | OTHER | 891051X | 05 | NC | MEDICAID | 080108995 | 01 | NC | RAILROAD MEDICARE | OTHER | NCM978D | 01 | NC | MEDICARE PTAN | OTHER | 1051X | 01 | NC | BLUE CROSS BLUE SHIELD | OTHER | 561852981G | 01 | NC | CIGNA | OTHER |