Individual
MARK FORDHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CP
Contact information
Practice address
451 RUIN CREEK RD, STE. 102, HENDERSON, NC 27536-2878
(252) 436-2611
Mailing address
451 RUIN CREEK RD, STE. 102, HENDERSON, NC 27536-2878
(252) 436-2611
Taxonomy
Speciality
Code
Description
License number
State
224P00000X
Prosthetist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7795152
—
NC
Enumeration date
06/29/2007
Last updated
08/05/2013
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