Unknown Individual – Family Medicine Physician, NPI 1104863828

Unknown Individual is a healthcare provider. based in Attleboro, Massachusetts. specializing in Family Medicine Physician. They hold a License No. 159447 (MA). The NPI Number for Unknown Individual is 1104863828

Main info

Organization
Inactive
30 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1104863828
Phone
(508) 761-5650
Address
562 WASHINGTON ST
Deactivation Date
8 November 2024

Doctor Profile

Medical School Name
ALBANY MEDICAL COLLEGE OF UNION UNIVERSITY
Secondary Phone
5087615650
Graduation Year
1996 (30 years ago)
PAC ID
9436170677
Group Practice PAC ID
0547203903
Professional Enrollment ID
I20051215000079
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

  • 562, Washington Street, South Attleboro, Attleboro, Bristol County, Massachusetts, 02861, United States

    ATTLEBORO, MA 027036942

    Phone: (508) 761-5650

    Fax: (508) 761-9870

    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 02703)

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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: 0547203903View full group profile

Reviews

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Frequently asked questions

How do I look up Unknown Individual by NPI?
Use NPI 1104863828 when you need to reference Unknown Individual in forms, claims, or directories.
How do I interpret inactive records for Unknown Individual?
Treat inactive as a signal to verify Unknown Individual through official channels.
What does Unknown Individual treat or focus on?
Patients typically see Unknown Individual under the specialty Family Medicine Physician. Clinical services aligned with this taxonomy classification.
Does Unknown Individual practice in Massachusetts?
You will see Attleboro, Massachusetts on file for Unknown Individual alongside any extra practice locations.
Is Unknown Individual a real provider?
This page reflects official NPPES data for NPI 1104863828. Always confirm identity and privileges with the practice and licensing boards.

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