Healthcare Provider Details

I. General information

NPI: 1528021052
Provider Name (Legal Business Name): MICHAIL CHARISSIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DILORENZO PENTAGON HEALTH CLINIC 5801 DEFENSE PENTAGON
WASHINGTON DC
20310-5285
US

IV. Provider business mailing address

9300 DEWITT LOOP
FORT BELVOIR VA
22060-5285
US

V. Phone/Fax

Practice location:
  • Phone: 703-692-8878
  • Fax:
Mailing address:
  • Phone: 571-231-4623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101102611
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: