Provider Demographics
NPI:1134153190
Name:FILSON, CHARLES RICHARD (EDD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:RICHARD
Last Name:FILSON
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 40709
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-0709
Mailing Address - Country:US
Mailing Address - Phone:202-333-5670
Mailing Address - Fax:703-281-1910
Practice Address - Street 1:2115 WISCONSIN AVE NW
Practice Address - Street 2:SUITE 200
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-2265
Practice Address - Country:US
Practice Address - Phone:202-333-5670
Practice Address - Fax:703-281-1910
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1682103G00000X
DCPSY1266103G00000X
PAPS-7869-L103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC2367OtherCAREFIRST BLUE CROSS #
156708Medicare PIN
DC2367OtherCAREFIRST BLUE CROSS #