Provider Demographics
NPI:1801882667
Name:FOSTER, BRADLEY SCOTT (MD)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:SCOTT
Last Name:FOSTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1911 N MILLS AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-1407
Mailing Address - Country:US
Mailing Address - Phone:407-893-8200
Mailing Address - Fax:
Practice Address - Street 1:1911 N MILLS AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1407
Practice Address - Country:US
Practice Address - Phone:407-893-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME157141207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3150402Medicaid
MAJ16529OtherBLUECROSS BLUESHIELD
MA3150402Medicaid
MAJ16529OtherBLUECROSS BLUESHIELD