Provider Demographics
NPI:1164518841
Name:MADSEN, BERIT L (MD)
Entity Type:Individual
Prefix:
First Name:BERIT
Middle Name:L
Last Name:MADSEN
Suffix:
Gender:F
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:P.O. BOX 60000
Mailing Address - Street 2:FILE 31163
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94160
Mailing Address - Country:US
Mailing Address - Phone:360-697-8000
Mailing Address - Fax:
Practice Address - Street 1:19917 7TH AVE NE
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-7403
Practice Address - Country:US
Practice Address - Phone:360-697-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000306902085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0039587OtherLABOR AND INDUSTRIES
WA920001720OtherRAILROAD MEDICARE
WAMA8437OtherBLUE SHIELD NUMBER
WAUS0862051OtherAETNA SPECIALIST PIN
AKMD036WAOtherALASKA MEDICAID
ID805180300OtherIDAHO MEDICAID
WA8152159Medicaid
WA000184146Medicare PIN
WAUS0862051OtherAETNA SPECIALIST PIN
WAG8883800Medicare PIN
WAMA8437OtherBLUE SHIELD NUMBER