Provider Demographics
NPI:1245568088
Name:PRENDERGAST, MICHAEL (MB BCH BAO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:PRENDERGAST
Suffix:
Gender:M
Credentials:MB BCH BAO
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Mailing Address - Street 1:300 LONGWOOD AVE ENDERS 961
Mailing Address - Street 2:CHILDREN'S HOSPITAL BOSTON
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115
Mailing Address - Country:US
Mailing Address - Phone:617-919-2341
Mailing Address - Fax:617-919-2341
Practice Address - Street 1:MASSACHUSETTS GENERAL HOSPITAL
Practice Address - Street 2:55 FRUIT ST.
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-724-9040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-04
Last Update Date:2011-02-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MAL-2395282080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine