Unknown Individual – Family Medicine Physician, NPI 1093064370

Unknown Individual is a healthcare provider. based in Taunton, Massachusetts. specializing in Family Medicine Physician. They hold a License No. RN2307973 (MA). The NPI Number for Unknown Individual is 1093064370

Main info

Organization
Inactive
14 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1093064370
Phone
(412) 817-2085
Address
350 HARVEY ST
Deactivation Date
12 March 2026

Doctor Profile

Medical School Name
OTHER
Secondary Phone
5086308989
Graduation Year
2012 (14 years ago)
PAC ID
6406134451
Group Practice PAC ID
1557639366
Professional Enrollment ID
I20161026002841
Data current as of
20 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

  • 350 HARVEY ST

    TAUNTON, MA 027807268

    Phone: (412) 817-2085

    Type: Mailing

  • 2 ADAMS PL STE 305

    QUINCY, MA 021697456

    Phone: (617) 302-4194

    Type: Location

  • 63 MAIN ST

    BROCKTON, MA 023014042

    Phone: (508) 559-6699

    Type: Location

  • 2 Adams Pl Ste 305

    Quincy, MA 021697456

    Phone: (617) 302-4194

    Type: Location

  • 680 Centre St

    Brockton, MA 023023308

    Phone: (508) 941-7202

    Fax: (508) 941-6334

    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 02780)

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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: 1557639366View full group profile
NameSpecialtyState
JESSICA HITCHCOCK (NP)
Nurse PractitionerMA
JESSICA LEE TADDEO (APRN)
Nurse PractitionerMA
ANGELA FARMER (PA)
Physician AssistantMA
MR. ANDREW C SECHREST (NP)
Nurse PractitionerRI
SUKHJIT KAUR (PA)
Physician AssistantMA
MORGAN JOHN CONWELL (PA-C)
Physician AssistantNY
KLAJDI KOSOVRASTI
Physician AssistantMA
BRIAN ONYECHEFULE
Physician AssistantMA
TAYLOR SHEA KEARNEY (FNP-C)
-MA
MR. THOMAS C BELTZ (PA-C)
-MA

Reviews

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Frequently asked questions

Can I cross-check Unknown Individual using NPI 1093064370?
NPI 1093064370 belongs to Unknown Individual; compare other details if you need extra assurance.
Is Unknown Individual still active if the NPI shows inactive?
NPPES shows Unknown Individual as inactive; dates on the record explain the timeline when available.
How would a patient describe Unknown Individual's focus?
For Unknown Individual, the primary taxonomy reads as Family Medicine Physician. Clinical services aligned with this taxonomy classification.
What locale is associated with Unknown Individual?
Directory geography for Unknown Individual centers on Taunton, Massachusetts.
Does inactive status remove historical data?
Historical rows can remain visible after status changes — read the dates carefully.

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