Unknown Individual – Emergency Medicine Physician, NPI 1710950191

Unknown Individual is a healthcare provider. based in Dover, Delaware. specializing in Emergency Medicine Physician. They hold a License No. C1-0006230 (DE). The NPI Number for Unknown Individual is 1710950191

Main info

Organization
Inactive
28 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1710950191
Phone
(302) 744-7121
Address
640 S STATE ST
Deactivation Date
6 December 2023

Doctor Profile

Medical School Name
JEFFERSON MEDICAL COLLEGE OF THOMAS JEFFERSON UNIVERSITY
Secondary Phone
4108221000
Graduation Year
1998 (28 years ago)
PAC ID
3072578673
Group Practice PAC ID
1759371677
Professional Enrollment ID
I20041123000481
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience23
Completeness75
Years active:0State licenses:2Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • Bayhealth Kent General, 640, South State Street, Morris Estates, Dover, Kent County, Delaware, 19901, United States

    DOVER, DE 199013530

    Phone: (302) 744-7121

    Type: Location

  • Arthursville Road, Hartly, Kent County, Delaware, 19938, United States

    HARTLY, DE 199532910

    Phone: (302) 492-8465

    Type: Mailing

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 19901)

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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: 1759371677View full group profile

Reviews

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Frequently asked questions

Can I verify Unknown Individual with an NPI only?
You can start verification with NPI 1710950191 for Unknown Individual, then check state licensing separately.
Is Unknown Individual's NPI deactivated?
The extract indicates Unknown Individual is not in an active NPI state.
What is Unknown Individual's specialty?
The listing groups Unknown Individual with Emergency Medicine Physician. Clinical services aligned with this taxonomy classification.
What address line appears for Unknown Individual?
Unknown Individual's geographic hint is Dover, Delaware in our summary view.
What does 'Individual Provider' mean on this profile?
Entity type tells you whether the number belongs to a person or an organization.

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