Basic Information
Provider Information | |||||||||
NPI: | 1942454533 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | FOSTER | ||||||||
FirstName: | KATRINA | ||||||||
MiddleName: | M | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 26005 RIDGE RD | ||||||||
Address2: | SUITE 200 | ||||||||
City: | DAMASCUS | ||||||||
State: | MD | ||||||||
PostalCode: | 208721892 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3014142300 | ||||||||
FaxNumber: | 3014142306 | ||||||||
Practice Location | |||||||||
Address1: | 26005 RIDGE RD | ||||||||
Address2: | SUITE 200 | ||||||||
City: | DAMASCUS | ||||||||
State: | MD | ||||||||
PostalCode: | 208721892 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3014142300 | ||||||||
FaxNumber: | 3014142306 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/09/2008 | ||||||||
LastUpdateDate: | 04/12/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | D0067239 | MD | Y |   | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |   |
ID Information
ID | Type | State | Issuer | Description | D0067239 | 01 | MD | MD LICENSE | OTHER | 021431100 | 05 | MD |   | MEDICAID |