Provider Demographics
NPI:1841287489
Name:PRENDERGAST, NEAL J JR (MD)
Entity type:Individual
Prefix:
First Name:NEAL
Middle Name:J
Last Name:PRENDERGAST
Suffix:JR
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 1:101 HOSPITAL BLVD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-3769
Mailing Address - Country:US
Mailing Address - Phone:812-282-3899
Mailing Address - Fax:812-282-4172
Practice Address - Street 1:101 HOSPITAL BLVD
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3769
Practice Address - Country:US
Practice Address - Phone:812-282-3899
Practice Address - Fax:812-282-4172
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY32911208800000X
IN01069486A208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
10805597OtherCAQH PROVIDER ID
KYP00314098OtherRAILROAD MEDICARE
IN201028550Medicaid
KYP00895260OtherRAILROAD MEDICARE
KY64329113Medicaid
KY0998203Medicare PIN
KYP00895260OtherRAILROAD MEDICARE
10805597OtherCAQH PROVIDER ID
KYP00314098OtherRAILROAD MEDICARE
IN201028550Medicaid