Provider Demographics
NPI:1598804288
Name:ROSS BERMAN, CARA J (LMP)
Entity Type:Individual
Prefix:MS
First Name:CARA
Middle Name:J
Last Name:ROSS BERMAN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 47TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98118-2319
Mailing Address - Country:US
Mailing Address - Phone:206-322-5118
Mailing Address - Fax:206-322-5104
Practice Address - Street 1:110 LAKESIDE AVE
Practice Address - Street 2:SUITE I
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-6594
Practice Address - Country:US
Practice Address - Phone:206-322-5118
Practice Address - Fax:206-322-5104
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00002077174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5335ROOtherREGENCE BLUE SHIELD