Provider Demographics
NPI:1356404990
Name:BERLIN, CHRISTOPHER JACK (MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:JACK
Last Name:BERLIN
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 1:2715 NACHES AVE SW
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-2627
Mailing Address - Country:US
Mailing Address - Phone:206-630-1330
Mailing Address - Fax:
Practice Address - Street 1:2715 NACHES AVE SW
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-2627
Practice Address - Country:US
Practice Address - Phone:206-630-1330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD432456207R00000X
WAMD60133766207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1356404990Medicaid