Basic Information
| Provider Information | |||||||||
| NPI: | 1508817222 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GHERMAY | ||||||||
| FirstName: | BERHAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1819 23RD AVE APT E305 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981222989 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2069730560 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1450 BATTERSBY AVE | ||||||||
| Address2: | |||||||||
| City: | ENUMCLAW | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980223634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3608252505 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2006 | ||||||||
| LastUpdateDate: | 10/06/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207PE0004X | MD065638L | PA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | Emergency Medical Services | 207P00000X | MD00042655 | WA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 700085 | 01 | PA | HIGHMARK BS | OTHER | 0017665510004 | 05 | PA | MEDICAID | 0459675000 | 01 | PA | INDEPENDENCE BC | OTHER |