Provider Demographics
NPI:1295828515
Name:BERKOWICZ, LOUISE (MD)
Entity Type:Individual
Prefix:
First Name:LOUISE
Middle Name:
Last Name:BERKOWICZ
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 1:7636 SE 72ND ST
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-5319
Mailing Address - Country:US
Mailing Address - Phone:206-459-2126
Mailing Address - Fax:
Practice Address - Street 1:5600 14TH AVE NW STE 1
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-3723
Practice Address - Country:US
Practice Address - Phone:206-919-0175
Practice Address - Fax:206-567-9797
Is Sole Proprietor?:No
Enumeration Date:2006-09-30
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00040194207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA3684BEOtherREGENCE RIDER NUMBER
WA0154940OtherLABOR & INDUSTRY NUMBER
WA8285272Medicaid
WAF94205Medicare UPIN
WA0154940OtherLABOR & INDUSTRY NUMBER