Unknown Individual – Neurology Physician, NPI 1386681963

Unknown Individual is a healthcare provider. based in Boston, Massachusetts. specializing in Neurology Physician. They hold a License No. 37857 (MA). The NPI Number for Unknown Individual is 1386681963

Main info

Organization
Inactive
55 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1386681963
Phone
(617) 667-4389
Address
330 BROOKLINE AVE
Deactivation Date
28 August 2024

Doctor Profile

Medical School Name
OTHER
Secondary Phone
6177548612
Graduation Year
1971 (55 years ago)
PAC ID
0648347492
Group Practice PAC ID
4486567104
Professional Enrollment ID
I20080922000238
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

  • Beth Israel Deaconess Medical Center East Campus, 330, Brookline Avenue, Audubon Square, Boston, Suffolk County, Massachusetts, 02215, United States

    BETH ISRAEL DEACONESS MEDICAL CENTER

    BOSTON, MA 022155400

    Phone: (617) 667-4389

    Type: Location

  • 2, Sheehan Circle, Wellesley, Norfolk County, Massachusetts, 02462, United States

    WELLESLEY, MA 024815501

    Phone: (617) 667-4389

    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

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.

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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 02215)

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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: 4486567104View full group profile

Reviews

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Frequently asked questions

Can I cross-check Unknown Individual using NPI 1386681963?
NPI 1386681963 belongs to Unknown Individual; compare other details if you need extra assurance.
Does inactive status mean Unknown Individual stopped practicing?
Inactive registry status can reflect deactivation, consolidation, or data lag.
What kind of doctor is Unknown Individual?
Unknown Individual is associated with Neurology Physician in the directory — Clinical services aligned with this taxonomy classification.
What locale is associated with Unknown Individual?
Directory geography for Unknown Individual centers on Boston, Massachusetts.
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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