Unknown Individual – Geriatric Psychiatry Physician, NPI 1033211404

Unknown Individual is a healthcare provider. based in Marblehead, Massachusetts. specializing in Geriatric Psychiatry Physician. They hold a License No. 31436 (MA). The NPI Number for Unknown Individual is 1033211404

Main info

Organization
Inactive
59 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1033211404
Phone
(781) 631-1777
Address
ONE WIDGER RD SUITE 309
Deactivation Date
26 February 2021

Doctor Profile

Medical School Name
UNIVERSITY OF COLORADO SCHOOL OF MEDICINE, DENVER
Secondary Phone
7816311777
Graduation Year
1967 (59 years ago)
PAC ID
4082640446
Professional Enrollment ID
I20050718000106
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience19
Completeness75
Years active:0State licenses:1Digital endpointsOther names

Provider Addresses for Unknown Individual

  • ONE WIDGER RD SUITE 309

    MARBLEHEAD, MA 019452146

    Phone: (781) 631-1777

    Fax: (781) 639-8003

    Type: Location

  • North Shore Medical Center - Salem Hospital, 81, Highland Avenue, Salem, Essex County, Massachusetts, 01970, United States

    NORTH SHORE HEALTH SYSTEMS

    SALEM, MA 01970

    Phone: (978) 354-4173

    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.

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Medicare Enrollment & Revalidation

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

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Medicare Utilization (FFS)

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

Insurance plans in this area (ZIP 01945)

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Provider's Procedures

Unknown Individual performs procedures in Geriatric Psychiatry Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
PSYCHIATRYMA90836Psychotherapy, 45 minutes with patient and/or family member29757

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Frequently asked questions

Is there an official ID for Unknown Individual in U.S. healthcare records?
The official identifier for Unknown Individual is NPI 1033211404.
Is inactive the same as retired for Unknown Individual?
Inactive registry status can reflect deactivation, consolidation, or data lag.
What kind of doctor is Unknown Individual?
Unknown Individual is associated with Geriatric Psychiatry Physician in the directory — Clinical services aligned with this taxonomy classification.
Is Unknown Individual located near Marblehead?
Unknown Individual currently maps to Marblehead, Massachusetts in this extract.
Can I trust this NPI listing for Unknown Individual?
The listing is sourced from the national NPI registry. If something looks off, compare with NPPES and the clinic's website.

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