EDWARD J PRENDERGAST


Address: 535 S Shore Dr, Madison, WI 53715-1703
Phone: 6082553786

EDWARD J PRENDERGAST (NPI# 1013963321) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1013963321
Entity Type Individual
Full Name EDWARD J PRENDERGAST
Credential MD
Practice Address 535 S Shore Dr
Madison
WI 53715-1703
Practice Telephone 6082553786
Mailing Telephone 6082553786
Enumeration Date 2006-05-26
Last Update Date 2014-02-03
Gender Code M
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 207RH0003X Internal Medicine
Specialization: Hematology & Oncology
19055-020 WI Allopathic & Osteopathic Physicians

Other Provider Identifier

State Issuer Identifier Type Code
WI DEAN HEALTH INSURANCE 117 01
WI 30330000 05

Office Location

Street Address 535 S SHORE DR
City MADISON
State WI
Zip Code 53715-1703

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1851807697 Kristi M Batchelor Nurse Practitioner 20 S Park St Fl 4, Madison, WI 53715 2017-12-15
1578927026 Petra A Kelsey Family Medicine 1107 Emerald St, Madison, WI 53715 2016-04-11
1467889238 Group Health Cooperative of South Central Wi Durable Medical Equipment & Medical Supplies 740 Regent Street, Suite 106, Madison, WI 53715 2013-10-10
1275888760 Sandra Beth Miller Physician Assistant 700 S. Park, Suite A 404, Madison, WI 53715 2012-07-20
1134418486 Matthew Lochen Emergency Medicine 700 S. Park Street, Department of Emergency Medicine, Madison, WI 53715 2011-04-06
1225275720 Eileen J Breitweiser Social Worker 202 South Parkt Street, Madison, WI 53715 2009-01-21
1225293137 Kenneth H. Yuska, Md, Sc Orthopaedic Surgery 4726 East Towne Blvd., 110, Madison, WI 53715 2008-07-21
1063689727 Rachel I Kornik Dermatology Uw Health Dept of Dermatology 1 S. Park St, Administrative Office 7th Floor, Madison, WI 53715 2008-05-13
1144434911 Rebecca Sue Frye Pharmacist 1 South Park Street, Suite 101 Pharmacy, Madison, WI 53715 2007-05-10
1376755496 Eileen C. Scrivner Social Worker 1008 Fish Hatchery Road, Madison, WI 53715 2007-05-03
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Taxonomy Information

Taxonomy Code 207RH0003X
Grouping Allopathic & Osteopathic Physicians
Classification Internal Medicine
Specialization Hematology & Oncology

Taxonomy Definition

An internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy that is board eligible/certified by the American Osteopathic Board of Internal Medicine WAS able to obtain a Certificate of Special Qualifications in the field of Hematology and Oncology. The Certificate is NO longer offered.
Notes: Source: American Osteopathic Board of Internal Medicine, 2007. [7/1/2008: definiton added, source added; 7/1/2011: modified source]
- Additional Resources: http://www.osteopathic.org/certification

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1356486591 Galen R Hasler Internal Medicine 350 S Hamilton St, 203, Madison, WI 53703-3861 2007-02-21
1710933965 Charles H Diggs Internal Medicine 1277 Deming Way, Dean Health Plan, Madison, WI 53717-1971 2006-05-26
1588630446 Michael S Huie Internal Medicine 106 Shepard Ter, Madison, WI 53705-3614 2006-02-28
1801884218 Linh Khuu Internal Medicine 1200 John Q Hammons Dr Ste 400, Dean Medical Center, Madison, WI 53717-1967 2005-10-10
1346762515 Ayesha Hassan Internal Medicine 600 Highland Ave, Madison, WI 53792-5018 2017-07-10
1326492430 Patrick Thomas Grogan Internal Medicine 600 Highland Ave., Uw Hospitals and Clinics, Madison, WI 53792 2016-04-15
1063874758 Chad Michael Guenther Internal Medicine Uw Hospitals & Clinics, 600 Highland Ave, Madison, WI 53792-0001 2016-03-22
1851702930 Ruqin Chen Internal Medicine 1 S Park St, Madison, WI 53715-1375 2014-05-12
1881004356 Monica Arun Patel Internal Medicine 600 Highland Ave, Madison, WI 53792-5000 2014-05-05
1598182974 Timothy Martin Schmidt Internal Medicine 600 Highland Ave, Madison, WI 53792-7232 2014-03-24
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City MADISON
Zip Code 53715

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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