Provider Demographics
NPI:1083670269
Name:BROSNAN, THOMAS MOCK (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:MOCK
Last Name:BROSNAN
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 1:900 CENTREPARK DRIVE
Mailing Address - Street 2:STE A
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28805
Mailing Address - Country:US
Mailing Address - Phone:828-254-9693
Mailing Address - Fax:828-254-9695
Practice Address - Street 1:900 CENTREPARK DRIVE
Practice Address - Street 2:STE A
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28805
Practice Address - Country:US
Practice Address - Phone:828-254-9693
Practice Address - Fax:828-254-9695
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89129MJMedicaid
NC129MJOtherBCBS NC
NC89129MJMedicaid
NCP00415239Medicare PIN
NC2293491AMedicare PIN