Provider Demographics
NPI:1528023348
Name:BERRY, ANNA B (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:B
Last Name:BERRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANNA
Other - Middle Name:B
Other - Last Name:O'GRADY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1124 COLUMBIA ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2048
Mailing Address - Country:US
Mailing Address - Phone:206-576-6053
Mailing Address - Fax:206-576-6527
Practice Address - Street 1:1124 COLUMBIA ST STE 200
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2048
Practice Address - Country:US
Practice Address - Phone:206-576-6053
Practice Address - Fax:206-576-6527
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA92151207ZC0500X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0A9215100Medicaid
CA0A9215100Medicare PIN
CA0A9215100Medicaid