Basic Information
| Provider Information | |||||||||
| NPI: | 1003828567 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MULFORD | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | BRODERICK | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 50 SCHENCK PKWY | ||||||||
| Address2: | |||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288033499 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286811527 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 76 PEACHTREE RD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288033505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282743477 | ||||||||
| FaxNumber: | 8282747407 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2006 | ||||||||
| LastUpdateDate: | 09/14/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 200200963 | NC | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 5902946 | 05 | NC | MEDICAID |