Healthcare Provider Details

I. General information

NPI: 1134153190
Provider Name (Legal Business Name): CHARLES RICHARD FILSON EDD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 05/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 WISCONSIN AVE NW SUITE 200
WASHINGTON DC
20007-2265
US

IV. Provider business mailing address

PO BOX 40709
WASHINGTON DC
20016-0709
US

V. Phone/Fax

Practice location:
  • Phone: 202-333-5670
  • Fax: 703-281-1910
Mailing address:
  • Phone: 202-333-5670
  • Fax: 703-281-1910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number1682
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY1266
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPS-7869-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: