Healthcare Provider Details

I. General information

NPI: 1154231199
Provider Name (Legal Business Name): CHARLES LINEBERGER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 RESERVOIR RD NW
WASHINGTON DC
20007-2111
US

IV. Provider business mailing address

2800 WISCONSIN AVE NW APT 811
WASHINGTON DC
20007-4707
US

V. Phone/Fax

Practice location:
  • Phone: 202-444-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246XC2901X
TaxonomyCardiovascular Invasive Specialist/Technologist
License NumberC00111239
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: