Healthcare Provider Details

I. General information

NPI: 1003235367
Provider Name (Legal Business Name): CHARLES JOHN BILLINGTON JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MICHIGAN AVE NW W3.5, 600
WASHINGTON DC
20010-2916
US

IV. Provider business mailing address

606 24TH AVE S STE 500
MINNEAPOLIS MN
55454-1455
US

V. Phone/Fax

Practice location:
  • Phone: 202-476-3670
  • Fax: 202-476-4741
Mailing address:
  • Phone: 612-624-5965
  • Fax: 612-626-2993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number67510
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number67510
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: