Unknown Individual – Nephrology Physician, NPI 1407840242

Unknown Individual is a healthcare provider. based in Brighton, Massachusetts. specializing in Nephrology Physician. They hold a License No. 60637 (MA). The NPI Number for Unknown Individual is 1407840242

Main info

Organization
Inactive
58 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1407840242
Phone
(617) 779-6700
Address
11 NEVINS ST
Deactivation Date
27 September 2024

Doctor Profile

Medical School Name
OTHER
Secondary Phone
-
Graduation Year
1968 (58 years ago)
PAC ID
6608785654
Group Practice PAC ID
2860688728
Professional Enrollment ID
I20040224000902
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

Loading map...

Provider Addresses for Unknown Individual

  • 11, Nevins Street, Aberdeen, Brighton, Boston, Suffolk County, Massachusetts, 02135, United States

    STE 202

    BRIGHTON, MA 021353514

    Phone: (617) 779-6700

    Fax: (617) 779-6771

    Type: Location

  • US Family Health Plan at Brighton Marine, 77, Warren Street, Aberdeen, Allston, Boston, Suffolk County, Massachusetts, 02135, United States

    RM 339

    BRIGHTON, MA 02135

    Phone: (617) 562-5359

    Fax: (617) 562-5415

    Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

Loading prescription activity...

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 02135)

Loading plans...

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: 2860688728View full group profile

Reviews

All reviews are moderated before publication. Reviews reflect users' opinions; we do not verify the accuracy of individual reviews.

No reviews yet. Be the first to share your experience — your opinion helps families compare providers.

Frequently asked questions

Can I verify Unknown Individual with an NPI only?
You can start verification with NPI 1407840242 for Unknown Individual, then check state licensing separately.
Is Unknown Individual excluded from programs when inactive?
The public NPI listing for Unknown Individual is not currently active; confirm directly with the practice or licensing boards.
What taxonomy line describes Unknown Individual?
For research purposes, treat Unknown Individual as Nephrology Physician in this dataset. Clinical services aligned with this taxonomy classification.
What address line appears for Unknown Individual?
Unknown Individual's geographic hint is Brighton, Massachusetts in our summary view.
What does 'Individual Provider' mean on this profile?
Entity type tells you whether the number belongs to a person or an organization.

Similar Providers

BERTRAND L. JABER (MD)

Nephrology Physician
Boston Medical Center – Brighton, 736, Cambridge Street, Brighton Center, Brighton, Boston, Suffolk County, Massachusetts, 02135, United States
NPI: 1588659445

JAMES A STROM (MD)

Nephrology Physician
St. Elizabeth's Medical Center, 736, Cambridge Street, Aberdeen, Brighton, Boston, Suffolk County, Massachusetts, 02135, United States
NPI: 1891785895

DR. TEJAS PATEL (MD)

Internal Medicine Physician
4 OHIO DRIVE
NPI: 1467421032
BMCHS PROVIDER ENROLLMENT
NPI: 1326095548
720 HARRISON AVE # DOB503
NPI: 1245320910

ALBERT Q LAM (M.D.)

Internal Medicine Physician
55 FRUIT ST
NPI: 1346430485

DR. SHADI S TARAZI (M.D.,)

Nephrology Physician
650 NE 32ND ST UNIT 607
NPI: 1164672424

CRISTIAN RIELLA (M.D.)

Nephrology Physician
330 BROOKLINE AVE
NPI: 1730492042

DR. NAVIN RATH GUPTA (M.D.)

Nephrology Physician
55 Fruit St
NPI: 1598047169