MEDICARE: DR. MICHAIL CHARISSIS M.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	2084P0800X	Psychiatry Physician	0101102611	VA

General Provider Information

NPI Number	:	1528021052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAIL CHARISSIS M.D.

Provider Business Mailing Address
First Line	:	9300 DEWITT LOOP
Second Line	:
City	:	FORT BELVOIR
State	:	VA
Zip	:	22060-5285
Country	:	US
Telephone Number	:	571-231-4623
Fax Number	:

Provider Business Practice Location Address
First Line	:	DILORENZO PENTAGON HEALTH CLINIC 5801 DEFENSE PENTAGON
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20310-5285
Country	:	US
Telephone Number	:	703-692-8878
Fax Number	:

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

Provider Enumeration Date	:	04/07/2006
Last Update Date	:	05/22/2025

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