Provider Demographics
NPI:1154478998
Name:BERKSON, JOSEPH K (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:K
Last Name:BERKSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 34581
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1581
Mailing Address - Country:US
Mailing Address - Phone:509-241-7349
Mailing Address - Fax:509-241-7628
Practice Address - Street 1:11511 NE 10TH ST
Practice Address - Street 2:MAILSTOP W464
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-8578
Practice Address - Country:US
Practice Address - Phone:425-502-3850
Practice Address - Fax:425-502-3868
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00015032207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8437808Medicaid
WAG000135510Medicare PIN
WAE99495Medicare UPIN
WA8437808Medicaid