Healthcare Provider Details

I. General information

NPI: 1881438364
Provider Name (Legal Business Name): WARREN J. PENDERGAST, M.D., PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2024
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 HOMEWOOD CT STE 220
RALEIGH NC
27609-5732
US

IV. Provider business mailing address

4700 HOMEWOOD CT STE 220
RALEIGH NC
27609-5732
US

V. Phone/Fax

Practice location:
  • Phone: 919-787-7125
  • Fax: 919-781-9952
Mailing address:
  • Phone: 919-787-7125
  • Fax: 919-781-9952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. WARREN JOSEF PENDERGAST
Title or Position: OWNER
Credential: MD
Phone: 919-787-7125