Provider Demographics
NPI:1922035021
Name:HALL, JONATHAN BERGH (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:BERGH
Last Name:HALL
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:PO BOX 5127
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98206-5127
Mailing Address - Country:US
Mailing Address - Phone:425-304-8431
Mailing Address - Fax:
Practice Address - Street 1:3927 RUCKER AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4833
Practice Address - Country:US
Practice Address - Phone:425-339-5422
Practice Address - Fax:425-339-5444
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00041279207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1184HAOtherBLUE SHIELD # VM
WAUS5817026OtherAETNA PCP PIN VM
WA8340978Medicaid
WAP00279718OtherRAILROAD MC # VM
WAP00279718OtherRAILROAD MC # VM
WAUS5817026OtherAETNA PCP PIN VM
WA8340978Medicaid