Provider Demographics
NPI:1649306408
Name:BILLINGS, CHARLES KELSO (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:KELSO
Last Name:BILLINGS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70053
Mailing Address - Country:US
Mailing Address - Phone:504-366-9707
Mailing Address - Fax:504-366-7502
Practice Address - Street 1:720 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70053
Practice Address - Country:US
Practice Address - Phone:504-366-9707
Practice Address - Fax:504-366-7502
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0135482084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
5M010Medicare ID - Type Unspecified
D04136Medicare UPIN