MEDICARE: DR. CHARLES RICHARD FILSON EDD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103G00000X	Clinical Neuropsychologist	1682	MD
2	103G00000X	Clinical Neuropsychologist	PSY1266	DC
3	103G00000X	Clinical Neuropsychologist	PS-7869-L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2367	OTHER	DC	CAREFIRST BLUE CROSS #

General Provider Information

NPI Number	:	1134153190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES RICHARD FILSON EDD

Provider Business Mailing Address
First Line	:	PO BOX 40709
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20016-0709
Country	:	US
Telephone Number	:	202-333-5670
Fax Number	:	703-281-1910

Provider Business Practice Location Address
First Line	:	2115 WISCONSIN AVE NW
Second Line	:	SUITE 200
City	:	WASHINGTON
State	:	DC
Zip	:	20007-2265
Country	:	US
Telephone Number	:	202-333-5670
Fax Number	:	703-281-1910

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	05/14/2010

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Directions to “ DR. CHARLES RICHARD FILSON EDD” Practice Location

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