Basic Information
| Provider Information | |||||||||
| NPI: | 1508869025 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FOSTER | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 68 DARST RD | ||||||||
| Address2: | |||||||||
| City: | BEAVERCREEK | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454403442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9375310132 | ||||||||
| FaxNumber: | 9375310134 | ||||||||
| Practice Location | |||||||||
| Address1: | 68 DARST RD | ||||||||
| Address2: | |||||||||
| City: | BEAVERCREEK | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454403442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9375310132 | ||||||||
| FaxNumber: | 9375310134 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2005 | ||||||||
| LastUpdateDate: | 01/14/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 01/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35064234F | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0122514 | 01 | OH | UNITED HEALTHCARE | OTHER | 421534506012 | 01 | OH | CHAMPUS/TRICARE | OTHER | 000000227881 | 01 | OH | UNICARE | OTHER | 000000227881 | 01 | OH | ANTHEM | OTHER | D6423402 | 01 | OH | HUMANA/CHOICECARE | OTHER | 35064234 | 01 | OH | MEDICAL LICENSE | OTHER | 638827 | 01 | OH | AETNA | OTHER | 080191703 | 01 | OH | RAILROAD MEDICARE | OTHER | 0980907 | 05 | OH | MEDICAID | 421534506080 | 01 | OH | CARESOURCE | OTHER |