=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760446306
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KEITH AARON BERNSTEIN MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/12/2006
-----------------------------------------------------
Last Update Date | 12/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 400 NE MOTHER JOSEPH PL
-----------------------------------------------------
City | VANCOUVER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98664-3200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-892-9664
-----------------------------------------------------
Fax | 360-892-9667
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19020 33RD AVE W STE 210
-----------------------------------------------------
City | LYNNWOOD
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98036-4748
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-563-1500
-----------------------------------------------------
Fax | 425-563-1374
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number | MD00044452
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2085N0700X
-----------------------------------------------------
Taxonomy Name | Neuroradiology Physician
-----------------------------------------------------
License Number | MD00044452
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------