Basic Information
| Provider Information | |||||||||
| NPI: | 1699726471 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MULLINS | ||||||||
| FirstName: | DIANE | ||||||||
| MiddleName: | LOUISE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 MEDICAL PARK DR | ||||||||
| Address2: | |||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288032493 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282530762 | ||||||||
| FaxNumber: | 8282544892 | ||||||||
| Practice Location | |||||||||
| Address1: | 509 BILTMORE AVE | ||||||||
| Address2: | PATHOLOGY DEPT | ||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282530763 | ||||||||
| FaxNumber: | 8282544892 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2006 | ||||||||
| LastUpdateDate: | 06/10/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZD0900X | 9800644 | NC | N | Allopathic & Osteopathic Physicians | Pathology | Dermatopathology | 207ZP0102X | 9800644 | NC | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 220029829 | 01 | NC | RAILROAD MEDICARE | OTHER | 891136M | 05 | NC | MEDICAID |