Pendergrast, Kenneth Roy
Pendergrast, Kenneth Roy is an individual health care provider with primary practice located at 2155 Apperson Dr , Salem VA 24153-7235. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Hospitalist. Allopathic & Osteopathic Physicians / Internal Medicine is his primary health care specialty. Pendergrast, Kenneth Roy can be contacted via phone (540) 444-2010.Contact Information
Primary practice address
2155 Apperson Dr
Salem VA 24153-7235
Phone: (540) 444-2010
Fax: (540) 444-2019
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 0101042805 | Virginia |
| Allopathic & Osteopathic Physicians / Hospitalist | 208M00000X | 04-45914 | Kansas |
| Allopathic & Osteopathic Physicians / Hospitalist | 208M00000X | 0101042805 | Virginia |
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 04-45914 | Kansas |
Profile Details
| NPI number | 1255304697 |
|---|---|
| LBN Legal business name | Pendergrast, Kenneth Roy |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Feb 8th, 2006 |
| Last updated | Nov 3rd, 2022 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1255304697 | NPPES |
| Virginia | MEDICAID | 6036732 | |
| Virginia | MEDICAID | 1255304697 |
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