Individual
MARK L PRENDERGAST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
707 BRYANT ST, STATESVILLE, NC 28677-4142
(704) 873-5224
Mailing address
650 SIGNAL HILL DRIVE EXT, PO BOX 1845, STATESVILLE, NC 28625-4353
(704) 873-4277
(704) 873-4511
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
31358
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8966734
—
NC
Enumeration date
11/03/2005
Last updated
01/25/2008
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