MEDICARE: DR. CHARLES A. FILANOSKY PH.D.

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	22571	CA
2	103G00000X	Clinical Neuropsychologist	017080-01	NY

General Provider Information

NPI Number	:	1609910256
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES A. FILANOSKY PH.D.

Provider Business Mailing Address
First Line	:	4444 GEARY BLVD
Second Line	:	SUITE 309C
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94118-3048
Country	:	US
Telephone Number	:	650-839-3486
Fax Number	:

Provider Business Practice Location Address
First Line	:	4444 GEARY BLVD
Second Line	:	SUITE 309C
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94118-3048
Country	:	US
Telephone Number	:	650-839-3486
Fax Number	:

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

Provider Enumeration Date	:	02/16/2007
Last Update Date	:	02/11/2022

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