Unknown Individual – Pediatric Surgery Physician, NPI 1396794012

Unknown Individual is a healthcare provider. based in Hershey, Pennsylvania. specializing in Pediatric Surgery Physician. They hold a License No. MD045923L (PA). The NPI Number for Unknown Individual is 1396794012

Main info

Organization
Inactive
45 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1396794012
Phone
(800) 243-1455
Address
PO BOX 858
Deactivation Date
14 March 2022

Doctor Profile

Medical School Name
TEMPLE UNIVERSITY SCHOOL OF MEDICINE
Secondary Phone
7175318202
Graduation Year
1981 (45 years ago)
PAC ID
6305866757
Group Practice PAC ID
3870405483
Professional Enrollment ID
I20051130000143
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

  • PO BOX 858

    MC A410

    HERSHEY, PA 170330858

    Phone: (800) 243-1455

    Type: Mailing

  • Hershey Medical Center, 500, University Drive, Hershey, Dauphin County, Pennsylvania, 17033, United States

    HERSHEY, PA 170332360

    Phone: (800) 243-1455

    Fax: (717) 531-4185

    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 17033)

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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: 3870405483View full group profile
NameSpecialtyState
P A T H O L O G YPA
Vascular SurgeryMD
O P H T H A L M O L O G YPA
-PA
Nurse PractitionerPA
-FL
-PA
-PA
P A T H O L O G YPA
Physician AssistantPA

Reviews

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Frequently asked questions

Is there an official ID for Unknown Individual in U.S. healthcare records?
The official identifier for Unknown Individual is NPI 1396794012.
Who updates status for Unknown Individual?
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 Pediatric Surgery Physician. Clinical services aligned with this taxonomy classification.
Where in Pennsylvania is Unknown Individual registered?
Use Hershey, Pennsylvania as the headline location for Unknown Individual here.
When was this NPI issued?
Enumeration for Unknown Individual is noted as not shown in this record where the registry provides it.

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