MEDICARE: MARISA KHAMIS PA

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	363AS0400X	Surgical Physician Assistant	PA200002377	DC

General Provider Information

NPI Number	:	1356149066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISA KHAMIS PA

Provider Business Mailing Address
First Line	:	3800 RESERVOIR RD NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20007-2113
Country	:	US
Telephone Number	:	734-516-9486
Fax Number	:

Provider Business Practice Location Address
First Line	:	2121 I ST NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20052-0086
Country	:	US
Telephone Number	:	202-994-2960
Fax Number	:

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

Provider Enumeration Date	:	03/06/2025
Last Update Date	:	02/20/2026

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Directions to “ MARISA KHAMIS PA” Practice Location

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