Provider Demographics
NPI:1134577042
Name:COLVIN, CHARISSE (MD)
Entity type:Individual
Prefix:DR
First Name:CHARISSE
Middle Name:
Last Name:COLVIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 OLD CASTLE POINT RD
Mailing Address - Street 2:
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12511
Mailing Address - Country:US
Mailing Address - Phone:845-831-2000
Mailing Address - Fax:
Practice Address - Street 1:41 CASTLE POINT RD
Practice Address - Street 2:
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-7004
Practice Address - Country:US
Practice Address - Phone:845-831-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-01
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3029262084P0805X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry