Provider Demographics
NPI:1760446306
Name:BERNSTEIN, KEITH AARON (MD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:AARON
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 1:19020 33RD AVE W STE 210
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-4748
Mailing Address - Country:US
Mailing Address - Phone:425-563-1500
Mailing Address - Fax:425-563-1374
Practice Address - Street 1:400 NE MOTHER JOSEPH PL
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-3200
Practice Address - Country:US
Practice Address - Phone:360-892-9664
Practice Address - Fax:360-892-9667
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000444522085N0700X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0362229OtherLNI-SWEDISH RADIA EDMONDS
WA0362231OtherLNI-EVERGREEN RADIA
WA0362229OtherLNI-RADIA REST OF WA
WA0362228OtherLNI-RADIA KING COUNTY
WA1018312Medicaid
WA8237950Medicaid