Unknown Individual – Internal Medicine Physician, NPI 1124283916

Unknown Individual is a healthcare provider. based in Chevy chase, Maryland. specializing in Internal Medicine Physician. They hold a License No. D0079730 (MD). The NPI Number for Unknown Individual is 1124283916

Main info

Organization
Inactive
25 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1124283916
Phone
(301) 869-9776
Address
5530 WISCONSIN AVE STE 530
Deactivation Date
22 February 2023

Doctor Profile

Medical School Name
OTHER
Secondary Phone
3018699776
Graduation Year
2001 (25 years ago)
PAC ID
2163588468
Group Practice PAC ID
5092991984
Professional Enrollment ID
I20120807000207
Data current as of
20 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

  • Wisconsin Avenue, Chevy Chase Village, Montgomery County, Maryland, 20815, United States

    CHEVY CHASE, MD 208154451

    Phone: (301) 869-9776

    Type: Location

  • 15825 Shady Grove Rd

    Suite 140

    Rockville, MD 208504008

    Phone: (301) 869-9776

    Fax: (301) 417-4947

    Type: Location

  • 43810, Central Station Drive, Ashburn, Loudoun County, Virginia, 20147, United States

    STE 160

    ASHBURN, VA 201477210

    Phone: (301) 869-9776

    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 20815)

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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: 5092991984View full group profile
NameSpecialtyState
Nurse PractitionerDC
Nurse PractitionerVA
-MD
Family PracticeMD
Family PracticeDC
-MD
-MD
Internal MedicineMA
Family PracticeVA
Internal Medicine, HospitalistGA

Reviews

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Frequently asked questions

What federal number belongs to Unknown Individual?
The federal identifier for Unknown Individual is NPI 1124283916.
Is Unknown Individual's inactive status permanent?
An inactive NPI does not by itself prove someone stopped practicing — check other sources.
What field does Unknown Individual work in?
You can think of Unknown Individual as practicing within Internal Medicine Physician. Clinical services aligned with this taxonomy classification.
What location metadata exists for Unknown Individual?
The page summarizes Chevy Chase, Maryland for Unknown Individual; expand the address list for detail.
Does Medicare enrollment show here?
Medicare enrollment screens are separate from the basic NPI extract shown here.

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