Healthcare Provider Details

I. General information

NPI: 1528023348
Provider Name (Legal Business Name): ANNA B. BERRY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNA B. O'GRADY MD

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 03/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1124 COLUMBIA ST STE 200
SEATTLE WA
98104-2048
US

IV. Provider business mailing address

1124 COLUMBIA ST STE 200
SEATTLE WA
98104-2048
US

V. Phone/Fax

Practice location:
  • Phone: 206-576-6053
  • Fax: 206-576-6527
Mailing address:
  • Phone: 206-576-6053
  • Fax: 206-576-6527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License NumberA92151
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberA92151
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: