Provider Demographics
NPI:1881438364
Name:WARREN J. PENDERGAST, M.D., PLLC
Entity type:Organization
Organization Name:WARREN J. PENDERGAST, M.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:JOSEF
Authorized Official - Last Name:PENDERGAST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-787-7125
Mailing Address - Street 1:4700 HOMEWOOD CT STE 220
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-5732
Mailing Address - Country:US
Mailing Address - Phone:919-787-7125
Mailing Address - Fax:919-781-9952
Practice Address - Street 1:4700 HOMEWOOD CT STE 220
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-5732
Practice Address - Country:US
Practice Address - Phone:919-787-7125
Practice Address - Fax:919-781-9952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-20
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty