Unknown Individual – Physician Assistant, NPI 1083604466

Unknown Individual is a healthcare provider. based in New haven, Connecticut. specializing in Physician Assistant. They hold a License No. 001278 (CT). The NPI Number for Unknown Individual is 1083604466

Main info

Organization
Inactive
24 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1083604466
Phone
Not provided
Address
PO BOX 9805
Deactivation Date
11 November 2023

Doctor Profile

Medical School Name
OTHER
Secondary Phone
2034537000
Graduation Year
2002 (24 years ago)
PAC ID
5890811954
Group Practice PAC ID
9436061736
Professional Enrollment ID
I20100925000358
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 9805, Northwest Ash Street, West Haven, Portland, Metro, Washington County, Oregon, 97229, United States

    NEW HAVEN, CT 065360805

    Phone:

    Type: Mailing

  • 800, Howard Avenue, New Haven, New Haven County, Connecticut, 06519, United States

    YALE PHYSICIANS BUILDING -3RD FLOOR

    NEW HAVEN, CT 065191369

    Phone: (203) 785-4176

    Fax: (203) 785-5886

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 06536)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 9436061736View full group profile
NameSpecialtyState
DR. BRIAN CHRISTOPHER CAMBI (M.D.)
Interventional Cardiology, Cardiovascular Disease (Cardiology)CT
FRANCESCA MONTANARI (MD)
H E M A T O L O G Y/ O N C O L O G YCT
MS. MARYAM GONDAL (M.D.)
Internal Medicine, NephrologySC
MATTHEW JOSEPH MCCONNELL (M.D.)
-CT
DR. DANICE KURUVILLA (M.D.)
-NC
JEANETTE M TETRAULT (MD)
Internal MedicineCT
LOUIS WANG (MD)
-CT
DR. PRAMOD BONDE (MD)
Cardiac SurgeryCT
DR. LUMING LI (MD)
-CT
Unknown Individual
-CT

Reviews

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Frequently asked questions

What is Unknown Individual's NPI number?
Unknown Individual's NPI is 1083604466 — the number used across U.S. healthcare to identify this provider.
Is Unknown Individual still active if the NPI shows inactive?
NPPES shows Unknown Individual as inactive; dates on the record explain the timeline when available.
What area of care is associated with Unknown Individual?
Unknown Individual's record emphasizes Physician Assistant. Clinical services aligned with this taxonomy classification.
Is Unknown Individual associated with New Haven?
Public fields place Unknown Individual around New Haven, Connecticut. Always confirm the exact site before visiting.
What does 2 location(s) imply?
2 practice locations appear in the available data.

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