Provider Demographics
NPI:1356149066
Name:KHAMIS, MARISA (PA)
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:KHAMIS
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 P ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20005-4594
Mailing Address - Country:US
Mailing Address - Phone:734-516-9486
Mailing Address - Fax:
Practice Address - Street 1:2121 I ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20052-0086
Practice Address - Country:US
Practice Address - Phone:202-994-2960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program