Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 034457 | CT |
Y | 208600000X | Surgeon | 034457 | CT |
N | 2082S0105X | Plastic Hand Surgeon | 034457 | CT |
NPI | 1568443125 |
---|---|
Provider Name | Dr. Stanley J Foster III |
First Address | Middlebury, CT 06762 |
Second Address | Middlebury, CT 06762 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2005 |
Last Update Date | 13/10/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
034457 | STATE LICENSE (01) | CT |
E52416 | (02) |