Provider Demographics
NPI:1164585600
Name:BERNSTEIN, GERALD (MD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:
Last Name:BERNSTEIN
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 1:1730 MINOR AVE
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1498
Mailing Address - Country:US
Mailing Address - Phone:206-267-2100
Mailing Address - Fax:206-267-2101
Practice Address - Street 1:11011 MERIDIAN AV NORTH
Practice Address - Street 2:SUITE 102
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133
Practice Address - Country:US
Practice Address - Phone:206-859-5777
Practice Address - Fax:206-859-5776
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00009715207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A04073Medicare UPIN
000100439Medicare ID - Type Unspecified