Provider Demographics
NPI:1952506024
Name:PRENDIVILLE, TERENCE WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:TERENCE
Middle Name:WILLIAM
Last Name:PRENDIVILLE
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 1:2702 LIGHTHOUSE PT E
Mailing Address - Street 2:APARTMENT 730
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-4759
Mailing Address - Country:US
Mailing Address - Phone:410-624-8987
Mailing Address - Fax:
Practice Address - Street 1:300 LONGWOOD AVENUE, BADER 209
Practice Address - Street 2:CHILDREN'S HOSPITAL BOSTON, DEPARTMENT OF CARDIOLOGY,
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5737
Practice Address - Country:US
Practice Address - Phone:617-355-2706
Practice Address - Fax:617-739-6282
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren