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NPI Code Detail

MEDICARE: DR. EMILY N PRENDERGAST MD

MEDICARE: DR. EMILY N PRENDERGAST MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207V00000XObstetrics & Gynecology Physician61704MN
2207V00000XObstetrics & Gynecology PhysicianA128699CA
3207V00000XObstetrics & Gynecology Physician125-057-984IL
4207VX0201XGynecologic Oncology Physician61704MN

General Provider Information

NPI Number : 1780995803
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. EMILY N PRENDERGAST MD
Provider Business Mailing Address
First Line : 2550 UNIVERSITY AVE W STE 110N
Second Line :
City : SAINT PAUL
State : MN
Zip : 55114-2001
Country : US
Telephone Number : 651-602-5311
Fax Number : 651-222-6786
Provider Business Practice Location Address
First Line : 910 E 26TH ST STE 100
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55404-4552
Country : US
Telephone Number : 612-884-6300
Fax Number : 612-884-6363
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2010
Last Update Date : 08/23/2023

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Directions to “ DR. EMILY N PRENDERGAST MD” Practice Location

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