Provider Demographics
NPI:1316993009
Name:BERSCH, BARRY J (MD)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:J
Last Name:BERSCH
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 1:16110 8TH AVE SW
Mailing Address - Street 2:STE A-1
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-2962
Mailing Address - Country:US
Mailing Address - Phone:206-246-1012
Mailing Address - Fax:206-242-4437
Practice Address - Street 1:16110 8TH AVE SW
Practice Address - Street 2:STE A-1
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-2962
Practice Address - Country:US
Practice Address - Phone:206-246-1012
Practice Address - Fax:206-242-4437
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00024327207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAA06239Medicare UPIN