Individual
DR. SCOTT D. PENDERGAST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
24075 COMMERCE PARK, BEACHWOOD, OH 44122-5846
(216) 831-5700
(216) 831-1959
Mailing address
24075 COMMERCE PARK, BEACHWOOD, OH 44122-5846
(216) 831-5700
(216) 831-1959
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
35-07-2687-P
OH
207WX0107X
Retina Specialist (Ophthalmology) Physician
Primary
35-072687
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2021869
—
OH
01
—
35-07-2687-P
OHIO LICENSE NUMBER
OH
Enumeration date
09/01/2005
Last updated
06/28/2021
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