Provider Demographics
NPI:1760549950
Name:BERG, DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:BERG
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 1:1229 MADISON STREET
Mailing Address - Street 2:SUITE 1090
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104
Mailing Address - Country:US
Mailing Address - Phone:206-215-3300
Mailing Address - Fax:206-215-3301
Practice Address - Street 1:1229 MADISON STREET
Practice Address - Street 2:SUITE 1090
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104
Practice Address - Country:US
Practice Address - Phone:206-215-3300
Practice Address - Fax:206-215-3301
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00035013207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1760549950Medicaid
225990OtherINTERNAL ID-MOTOR VEHICLE ID
WA0230738OtherL&I
WA1760549950Medicaid
AB01071Medicare PIN