Individual
DR. KENNETH ROY PENDERGRAST
Active
Individual
DR. KENNETH ROY PENDERGRAST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
0101042805
VA
207R00000X
Internal Medicine Physician
Primary
04-45914
KS
207R00000X
Internal Medicine Physician
2022-01804
NC
208M00000X
Hospitalist Physician
0101042805
VA
208M00000X
Hospitalist Physician
04-45914
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1255304697
—
VA
05
—
6036732
—
VA
Enumeration date
02/08/2006
Last updated
08/05/2026
Update your record
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