Individual
DR. CHARLES KENNETH FOULSHAM II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
401 HIGH STREET, LOCK HAVEN, PA 11774-0117
(570) 748-6777
(570) 748-0110
Mailing address
PO BOX 117, LOCK HAVEN, PA 17745-0117
(570) 748-6777
(570) 748-0110
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
MD026474E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0008614940001
—
PA
01
—
058467
BLUE CROSS BLUE SHIELD
PA
01
—
18639
GEISINGER HEALTH PLAN
PA
Enumeration date
12/28/2006
Last updated
11/11/2008
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