Active NPI
Thomas W Prendergast, MD
- Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
- Easton, PA
National Provider Identifier
1881617645
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
- License
- MD064702L
- Practice address
- 2005 Fairview Ave
Suite a
Easton, PA 18042-3915 - Phone
- (610) 923-5200
- Fax
- (610) 923-5272
- NPI assigned
- Jul 25, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | 208G00000X | 25MA06864200 | NJ | |
| Transplant Surgery Physician | 204F00000X | 25MA06864200 | NJ | |
| Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | 208G00000X | 2015010868 | MO | |
| Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | 208G00000X | MD064702L | PA | Primary |
Addresses
Primary practice location
2005 Fairview Ave
Suite a
Easton, PA 18042-3915
Mailing address
2005 Fairview Ave
Suite a
Easton, PA 18042-3915
Phone (610) 923-5200
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7496303 | Medicaid | NJ | |
| P007151069 | Other | NJ | RR MCR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2015010868 | MO | MD | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153785600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1474329600000",
"number": "1881617645",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2005 FAIRVIEW AVE",
"address_2": "SUITE A",
"city": "EASTON",
"state": "PA",
"postal_code": "180423915",
"telephone_number": "610-923-5200",
"fax_number": "610-923-5272"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2005 FAIRVIEW AVE",
"address_2": "SUITE A",
"city": "EASTON",
"state": "PA",
"postal_code": "180423915",
"telephone_number": "610-923-5200",
"fax_number": "610-923-5272"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PRENDERGAST",
"first_name": "THOMAS",
"middle_name": "W",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-25",
"last_updated": "2016-09-20",
"status": "A"
},
"taxonomies": [
{
"code": "208G00000X",
"taxonomy_group": "",
"desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
"state": "NJ",
"license": "25MA06864200",
"primary": false
},
{
"code": "204F00000X",
"taxonomy_group": "",
"desc": "Transplant Surgery",
"state": "NJ",
"license": "25MA06864200",
"primary": false
},
{
"code": "208G00000X",
"taxonomy_group": "",
"desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
"state": "MO",
"license": "2015010868",
"primary": false
},
{
"code": "208G00000X",
"taxonomy_group": "",
"desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
"state": "PA",
"license": "MD064702L",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7496303",
"state": "NJ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MCR",
"identifier": "P007151069",
"state": "NJ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Easton, PA
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- Hugh Joseph Prentice, DO
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- Private Healthcare Facilities
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.