Provider Demographics
NPI:1962821991
Name:COLEMAN, BERTHINA B (MD)
Entity Type:Individual
Prefix:
First Name:BERTHINA
Middle Name:B
Last Name:COLEMAN
Suffix:
Gender:F
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 50095
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98145-5095
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:747 BROADWAY, SUITE WW- 739
Practice Address - Street 2:SWEDISH MEDICAL CENTER, GENERAL SURGERY RESIDENCY PROGR
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-4307
Practice Address - Country:US
Practice Address - Phone:206-386-2123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-07
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD608811082085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1962821991Medicaid