Basic Information
Provider Information
NPI: 1851031710
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FOSTER
FirstName: ADAM
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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OtherMiddleName:  
OtherNamePrefix:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 280 CHESTNUT ST FL 2
Address2:  
City: SPRINGFIELD
State: MA
PostalCode: 011991001
CountryCode: US
TelephoneNumber: 4137945700
FaxNumber:  
Practice Location
Address1: 3300 MAIN STREET
Address2: 2ND FL, STE A
City: SPRINGFIELD
State: MA
PostalCode: 011071112
CountryCode: US
TelephoneNumber: 4137942273
FaxNumber: 4137940198
Other Information
ProviderEnumerationDate: 03/30/2022
LastUpdateDate: 09/29/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 09/29/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000X174577CTN Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 
363LF0000XRN2314988MAY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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