Unknown Individual – Psychiatry Physician, NPI 1891760112

Unknown Individual is a healthcare provider. based in Hagerstown, Maryland. specializing in Psychiatry Physician. They hold a License No. D0047090 (MD). The NPI Number for Unknown Individual is 1891760112

Main info

Organization
Inactive
36 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1891760112
Phone
(301) 733-0331
Address
13218 BROOKLANE DR
Deactivation Date
10 February 2022

Doctor Profile

Medical School Name
MICHIGAN STATE UNIVERSITY COLLEGE OF HUMAN MEDICINE
Secondary Phone
4107805203
Graduation Year
1990 (36 years ago)
PAC ID
3274682836
Group Practice PAC ID
3476777947
Professional Enrollment ID
I20110606000379
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

  • 13218 BROOKLANE DR

    HAGERSTOWN, MD 217421435

    Phone: (301) 733-0331

    Fax: (301) 733-4038

    Type: Mailing

  • Brook Lane, 13121, Brook Lane, Bowmans Mill, Hagerstown, Washington County, Maryland, 21742, United States

    HAGERSTOWN, MD 21742

    Phone: (301) 733-0330

    Fax: (301) 733-4038

    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 21742)

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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: 3476777947View full group profile
NameSpecialtyState
Nurse PractitionerMD
Clinical Social WorkerMD
Clinical Social WorkerMD
Mental Health CounselorVA
Clinical Social WorkerMD
-MD
Mental Health CounselorMD
Clinical Social WorkerMD
Clinical Social WorkerMD
Clinical Social WorkerMD

Reviews

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Frequently asked questions

How is Unknown Individual identified in CMS data?
CMS-hosted NPPES data lists Unknown Individual with NPI 1891760112.
Is Unknown Individual excluded from programs when inactive?
The public NPI listing for Unknown Individual is not currently active; confirm directly with the practice or licensing boards.
What is Unknown Individual's primary classification?
Psychiatry Physician is the headline specialty for Unknown Individual here. Clinical services aligned with this taxonomy classification.
What address line appears for Unknown Individual?
Unknown Individual's geographic hint is Hagerstown, Maryland in our summary view.
Why does Unknown Individual have multiple addresses?
2 practice locations appear in the available data. Multiple addresses are common for hospital privileges, telehealth, or multi-site groups.

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