Active NPI
Michael NA Wannon, PH.D.
- Clinical Psychologist
- Chevy Chase, MD
National Provider Identifier
1821287178
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 3122
- Practice address
- 5454 Wisconsin Ave
Suite 1215
Chevy Chase, MD 20815-6901 - Phone
- (301) 951-9488
- Fax
- (301) 654-8571
- NPI assigned
- Oct 22, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 3122 | MD | Primary |
Addresses
Primary practice location
5454 Wisconsin Ave
Suite 1215
Chevy Chase, MD 20815-6901
Mailing address
5454 Wisconsin Ave
Suite 1215
Chevy Chase, MD 20815-6901
Phone (301) 951-9488
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Jan 1, 2012 through Jan 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3122 | MD | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1193011200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1193011200000",
"number": "1821287178",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5454 WISCONSIN AVE",
"address_2": "SUITE 1215",
"city": "CHEVY CHASE",
"state": "MD",
"postal_code": "208156901",
"telephone_number": "301-951-9488",
"fax_number": "301-654-8571"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5454 WISCONSIN AVE",
"address_2": "SUITE 1215",
"city": "CHEVY CHASE",
"state": "MD",
"postal_code": "208156901",
"telephone_number": "301-951-9488",
"fax_number": "301-654-8571"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WANNON",
"first_name": "MICHAEL",
"middle_name": "NA",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-10-22",
"last_updated": "2007-10-22",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MD",
"license": "3122",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chevy Chase, MD
- Godiza Marie Wallace
- Ryan McDonald Walley, M.D.
- Ashley Tremblay Walton, PA-C
- Angela Wang
- Judy Wang, LCPC, CPC
- Carla Marie Ward, MD
- Washington Behavioral Medicine Associates, LLC
- Washington Concierge Medical Group, LLC
- Washington Eye Physicians & Surgeons, P.C.
- Washington Nephrology Associates, L.L.P.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.