Provider Demographics
NPI:1891800124
Name:KARISHEV, NATALIE (MD)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:KARISHEV
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NATALYA
Other - Middle Name:
Other - Last Name:KARYSHEVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2320 WOOLSEY ST STE 201
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-1975
Mailing Address - Country:US
Mailing Address - Phone:510-843-8002
Mailing Address - Fax:510-845-7820
Practice Address - Street 1:2320 WOOLSEY ST STE 201
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-1975
Practice Address - Country:US
Practice Address - Phone:510-843-8002
Practice Address - Fax:510-540-4808
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2022-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA 105280207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA432463Medicaid
ME432680099Medicaid
MENONEOtherRESIDENT-NO PROV #S
CA9699539Medicaid
CA9699539Medicaid