Healthcare Provider Details

I. General information

NPI: 1225442890
Provider Name (Legal Business Name): NIALL THOMAS PRENDERGAST MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2014
Last Update Date: 07/15/2021
Certification Date: 07/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3459 FIFTH AVENUE NW62 UPMC MONTEFIORE HOSPITAL
PITTSBURGH PA
15213
US

IV. Provider business mailing address

3600 FORBES AVENUE FORBES TOWER - PLAZA LEVEL SUITE 140
PITTSBURGH PA
15213
US

V. Phone/Fax

Practice location:
  • Phone: 412-648-3098
  • Fax: 314-362-6959
Mailing address:
  • Phone: 314-454-8082
  • Fax: 314-362-7491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2017016679
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberMD474835
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMD474835
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD474835
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: