Provider Demographics
NPI:1396943478
Name:BERNSON, MARC ISRAEL (PA-C)
Entity type:Individual
Prefix:MR
First Name:MARC
Middle Name:ISRAEL
Last Name:BERNSON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10507 156TH ST E
Mailing Address - Street 2:SUITE G112
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-9361
Mailing Address - Country:US
Mailing Address - Phone:253-477-5053
Mailing Address - Fax:253-477-5098
Practice Address - Street 1:MADIGAN ARMY MEDICAL HOSPITAL
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-9361
Practice Address - Country:US
Practice Address - Phone:253-477-5053
Practice Address - Fax:253-477-5076
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60152451363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical