Provider Demographics
NPI:1508817222
Name:GHERMAY, BERHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:BERHAN
Middle Name:
Last Name:GHERMAY
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 1:1819 23RD AVE APT E305
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-2989
Mailing Address - Country:US
Mailing Address - Phone:206-973-0560
Mailing Address - Fax:
Practice Address - Street 1:1450 BATTERSBY AVE
Practice Address - Street 2:
Practice Address - City:ENUMCLAW
Practice Address - State:WA
Practice Address - Zip Code:98022-3634
Practice Address - Country:US
Practice Address - Phone:360-825-2505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD065638L207PE0004X
WAMD00042655207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA700085OtherHIGHMARK BS
PA0017665510004Medicaid
PA0459675000OtherINDEPENDENCE BC
H05116Medicare UPIN
PA032109NAAMedicare ID - Type Unspecified