Basic Information
| Provider Information | |||||||||
| NPI: | 1326019167 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BERNSTEIN | ||||||||
| FirstName: | CRYSTAL | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 34888 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981241888 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4259774620 | ||||||||
| FaxNumber: | 4257459836 | ||||||||
| Practice Location | |||||||||
| Address1: | 11027 MERIDIAN AVE N | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981331705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2063654492 | ||||||||
| FaxNumber: | 2063683456 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2006 | ||||||||
| LastUpdateDate: | 03/17/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | MD00041540 | WA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 1007674 | 05 | WA | MEDICAID | 0176555 | 01 | WA | LABOR AND INDUSTRIES | OTHER |