Unknown Individual – Social Worker, NPI 1902177264

Unknown Individual is a healthcare provider. based in Cumberland, Maryland. specializing in Social Worker. They hold a License No. 17641 (MD). The NPI Number for Unknown Individual is 1902177264

Main info

Organization
Inactive
16 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1902177264
Phone
(240) 964-8585
Address
12502 WILLOWBROOK RD
Deactivation Date
19 August 2022

Doctor Profile

Medical School Name
OTHER
Secondary Phone
2403627444
Graduation Year
2010 (16 years ago)
PAC ID
4981992245
Group Practice PAC ID
6204140254
Professional Enrollment ID
I20161019002266
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

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

Provider Addresses for Unknown Individual

  • 12502 WILLOWBROOK RD

    SUITE 380

    CUMBERLAND, MD 215026491

    Phone: (240) 964-8585

    Fax: (240) 964-8586

    Mailing address matches the actual address.

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 21502)

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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: 6204140254View full group profile
NameSpecialtyState
Nurse PractitionerMD
Mental Health CounselorWV
-MD
-MD
-MD
Internal MedicineMD
Nurse PractitionerMD
Mental Health CounselorPA
Clinical PsychologistNC
Clinical Social WorkerMD

Reviews

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Frequently asked questions

What NPI should I save for Unknown Individual?
Save NPI 1902177264 if you need a stable reference for Unknown Individual.
Is Unknown Individual's inactive status permanent?
An inactive NPI does not by itself prove someone stopped practicing — check other sources.
Does Unknown Individual list a primary specialty?
If you are matching referrals, note Social Worker for Unknown Individual. Clinical services aligned with this taxonomy classification.
Does Unknown Individual practice in Maryland?
You will see Cumberland, Maryland on file for Unknown Individual alongside any extra practice locations.
Does Medicare enrollment show here?
Medicare enrollment screens are separate from the basic NPI extract shown here.

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