Unknown Individual – Child & Adolescent Psychiatry Physician, NPI 1619967304

Unknown Individual is a healthcare provider. based in Charlestown, Massachusetts. specializing in Child & Adolescent Psychiatry Physician. They hold a License No. 43214 (MA). The NPI Number for Unknown Individual is 1619967304

Main info

Organization
Inactive
55 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1619967304
Phone
(617) 726-1743
Address
PO BOX 9142
Deactivation Date
1 March 2023

Doctor Profile

Medical School Name
OTHER
Secondary Phone
6177240287
Graduation Year
1971 (55 years ago)
PAC ID
3779567847
Group Practice PAC ID
2466365820
Professional Enrollment ID
I20040616000359
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

  • Charlestown Post Office (mobile), Pattern Close, St Austell Bay, Charlestown, Cornwall, England, PL25 3FQ, United Kingdom

    CHARLESTOWN, MA 021299142

    Phone: (617) 726-1743

    Fax: (617) 724-3742

    Type: Mailing

  • Massachusetts General Hospital, 55, Fruit Street, Beacon Hill, Boston, Suffolk County, Massachusetts, 02114, United States

    YAW 6900

    BOSTON, MA 021142621

    Phone: (617) 726-2724

    Fax: (617) 726-7541

    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 02129)

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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: 2466365820View full group profile
NameSpecialtyState
G A S T R O E N T E R O L O G YMA
Diagnostic RadiologyMA
Nephrology, Internal MedicineMA
Nurse PractitionerMA
P A T H O L O G YNY
P A T H O L O G YMA
P S Y C H I A T R YMA
Cardiac Electrophysiology, Internal Medicine, Cardiovascular Disease (Cardiology)MA
H E M A T O L O G Y/ O N C O L O G YMA
N E U R O L O G YMA

Reviews

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Frequently asked questions

What federal number belongs to Unknown Individual?
The federal identifier for Unknown Individual is NPI 1619967304.
Should I trust care from Unknown Individual if status is inactive?
An inactive NPI does not by itself prove someone stopped practicing — check other sources.
Can you summarize Unknown Individual's specialty in plain language?
Clinically, the directory lists Unknown Individual with Child & Adolescent Psychiatry Physician. Clinical services aligned with this taxonomy classification.
Does Unknown Individual practice in Massachusetts?
You will see Charlestown, Massachusetts on file for Unknown Individual alongside any extra practice locations.
How can I contact Unknown Individual?
Phone or fax may appear on the official NPI record when supplied — verify before relying on them.

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