Doctor Name: | TIMOTHY LEE PENDERGRASS |
NPI Number: | 1588651020 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | 5757 |
Business Practice Address: | 300 Tuskegee Blvd 436 Mdg Cc Ste 1b22 Dover Afb, DE - 199025300 |
Business Phone Number: | 3026772525 |
Business Fax Number: | 3026772526 |
Mailing Address: | 300 Tuskegee Blvd, 436 Mdg Cc Ste 1b22 DOVER AFB |
State: | DE |
Postal Code: | 199025300 |
Phone Number: | 3026772525 |
Fax Number: | 3026772526 |
NPI Enumeration Date: | 09/30/2005 |
NPI Last Update Date: | 01/22/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2085R0202X |
License Number: | 5757 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ND |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Radiology |
Taxonomy Specialization: | Diagnostic Radiology |
Taxonomy Definition: | A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |