Healthcare Provider Details

I. General information

NPI: 1164518841
Provider Name (Legal Business Name): BERIT L MADSEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19917 7TH AVE NE
POULSBO WA
98370-7403
US

IV. Provider business mailing address

P.O. BOX 60000 FILE 31163
SAN FRANCISCO CA
94160
US

V. Phone/Fax

Practice location:
  • Phone: 360-697-8000
  • Fax:
Mailing address:
  • Phone: 360-697-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberMD-21280
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberMD00030690
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: