Provider Demographics
NPI:1568411379
Name:PENDRAK, ELAINE G (DO)
Entity Type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:G
Last Name:PENDRAK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 DEKALB PIKE
Mailing Address - Street 2:
Mailing Address - City:NORRISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19401-2035
Mailing Address - Country:US
Mailing Address - Phone:610-272-0190
Mailing Address - Fax:610-272-4428
Practice Address - Street 1:2705 DEKALB PIKE STE 202
Practice Address - Street 2:
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19401
Practice Address - Country:US
Practice Address - Phone:610-275-7240
Practice Address - Fax:610-275-0633
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005567L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0047259001OtherIBC
PA1011410Medicaid
136618OtherHIGHMARK BS
PE136618Medicare ID - Type Unspecified
PA1011410Medicaid