Individual
DR. PRABHAKAR DAMODAR PENDSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2131 S 17TH ST, WILMINGTON, NC 28401-7407
(910) 815-5830
(910) 815-5698
Mailing address
PO BOX 602484, CHARLOTTE, NC 28260-2484
(910) 815-5830
(910) 815-5698
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
17733
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1588602122
—
NC
01
—
183728
MEDCOST
NC
01
—
4098357
AETNA
NC
01
—
66735
BCBS NC
NC
05
—
8966735
—
NC
Enumeration date
06/04/2006
Last updated
02/07/2014
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