Healthcare Provider Details

I. General information

NPI: 1841287489
Provider Name (Legal Business Name): NEAL J PRENDERGAST JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 08/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 HOSPITAL BLVD
JEFFERSONVILLE IN
47130-3769
US

IV. Provider business mailing address

101 HOSPITAL BLVD
JEFFERSONVILLE IN
47130-3769
US

V. Phone/Fax

Practice location:
  • Phone: 812-282-3899
  • Fax: 812-282-4172
Mailing address:
  • Phone: 812-282-3899
  • Fax: 812-282-4172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number32911
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number01069486A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: