Provider Demographics
NPI:1538119375
Name:BERMINGHAM, JOYCE MICHELLE (MD)
Entity type:Individual
Prefix:DR
First Name:JOYCE
Middle Name:MICHELLE
Last Name:BERMINGHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 N CHELAN AVE
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-2028
Mailing Address - Country:US
Mailing Address - Phone:509-663-8711
Mailing Address - Fax:
Practice Address - Street 1:820 N CHELAN AVE
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-2028
Practice Address - Country:US
Practice Address - Phone:509-663-8711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN44645207W00000X
WAMD60180624207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1538119375Medicaid
MN280425500Medicaid
WA315386OtherL&I POST 7/21/13
WAP01257179OtherRR MEDICARE
H70493Medicare UPIN
WA1538119375Medicaid
WAG8920310, G8920311Medicare PIN
WA1010370Medicaid
MN280425500Medicaid
WAG8920310Medicare PIN