Provider Demographics
NPI:1003828567
Name:MULFORD, THOMAS BRODERICK (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:BRODERICK
Last Name:MULFORD
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 1:50 SCHENCK PKWY
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-3499
Mailing Address - Country:US
Mailing Address - Phone:828-681-1527
Mailing Address - Fax:
Practice Address - Street 1:76 PEACHTREE RD
Practice Address - Street 2:SUITE 300
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-3505
Practice Address - Country:US
Practice Address - Phone:828-274-3477
Practice Address - Fax:828-274-7407
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2017-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200200963207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5902946Medicaid
NC5902946Medicaid
NC2045616Medicare PIN