Dominic Philip Tannoia, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

06643 Issued in MD

Practice address

5225 Wisconsin Ave NW
Washington, DC 20015-2014

Phone

(202) 363-1010

NPI assigned

May 26, 2020

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Dec 28, 2023 through Dec 28, 2027

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Stony Run Psychology & Wellness, LLC

  • Psychologist
  • Baltimore, MD
  • NPI 1023642675
  NPD (past)
• The Ross Center of Northern Virginia, PLLC

  • Adult Mental Health Clinic/Center
  • Vienna, VA
  • NPI 1568092948
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1590451200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703721600000",
    "number": "1164045183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3302 LANCER PL",
            "city": "HYATTSVILLE",
            "state": "MD",
            "postal_code": "207823153",
            "telephone_number": "207-749-5666"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5225 WISCONSIN AVE NW",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200152014",
            "telephone_number": "202-363-1010"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1595 Spring Hill Rd Ste 520",
            "address_purpose": "LOCATION",
            "city": "Vienna",
            "state": "VA",
            "postal_code": "221824101",
            "country_code": "US",
            "telephone_number": "703-687-6610",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TANNOIA",
        "first_name": "DOMINIC",
        "middle_name": "PHILIP",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-05-26",
        "last_updated": "2023-12-28",
        "certification_date": "2023-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MD",
            "license": "06643",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Donna Katherine Tanner, MSW, LICSW
• Edward James Tanner III, M.D.
• Keona Tanner
• Roman Tanner
• Sherri Lavette Tanner
• Line Sandra Sandra Tanonko Mafeugong
• Ryan Edward Tansek, MD
• Joelle Tansey, MPH, MSN, CRNP
• Pamela Tansinda
• Adeline Tanteh

• All providers in Washington, DC
• Psychologist in District of Columbia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.