Provider Demographics
NPI:1437119757
Name:PRENDERGAST, JOHN M (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:PRENDERGAST
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1350 LOCUST ST
Mailing Address - Street 2:SUITE G102
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15219-4738
Mailing Address - Country:US
Mailing Address - Phone:412-232-8494
Mailing Address - Fax:412-232-8727
Practice Address - Street 1:1350 LOCUST ST
Practice Address - Street 2:STE G102 BUILDING C
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15219-4738
Practice Address - Country:US
Practice Address - Phone:412-232-8494
Practice Address - Fax:412-232-8727
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038722E173000000X, 174400000X
173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001099400Medicaid
PA001099400Medicaid