Individual
KATHLEEN PRENDERGAST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
300 HOSPITAL DR, SUITE 119, GLEN BURNIE, MD 21061-6902
(410) 787-4940
Mailing address
301 HOSPITAL DR, GLEN BURNIE, MD 21061-5803
(410) 787-4594
(410) 787-4846
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
D0063787
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1080315
AETNA HMO
MD
01
—
108887
JOHNS HOPKINS HEALTH CARE
MD
01
—
194995
AMERIGROUP
MD
01
—
3301092
UHC/AMERICHOICE
MD
05
—
403539901
—
MD
01
—
4987
BRAVO/ ELDER HEALTH
MD
01
—
5831489
AETNA PPO
MD
01
—
62213902
CAREFIRST BLUE CROSS
MD
01
—
7973311
CIGNA
MD
01
—
F591-0022
CAREFIRST BLUE CROSS
DC
Enumeration date
10/28/2005
Last updated
10/16/2014
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