Unknown Individual – Otolaryngology Physician, NPI 1629078563

Unknown Individual is a healthcare provider. based in Gettysburg, Pennsylvania. specializing in Otolaryngology Physician. They hold a License No. MD425368 (PA). The NPI Number for Unknown Individual is 1629078563

Main info

Organization
Inactive
29 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1629078563
Phone
(717) 334-8171
Address
508 S WASHINGTON ST
Deactivation Date
25 January 2023

Doctor Profile

Medical School Name
TEMPLE UNIVERSITY SCHOOL OF MEDICINE
Secondary Phone
4106375700
Graduation Year
1997 (29 years ago)
PAC ID
5799734224
Group Practice PAC ID
3779495858
Professional Enrollment ID
I20110331000402

Contacts

SOAP Endpoint
https://careepiceast.kp.org:14430/Interconnect-prodmam/wcf/epic.community.hie/xcpdrespondinggat
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience28
Completeness85
Years active:0State licenses:2Other namesUpdated within 12 months

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Provider Addresses for Unknown Individual

  • 508, South Washington Street, Gettysburg, Adams County, Pennsylvania, 17325, United States

    GETTYSBURG, PA 173252594

    Phone: (717) 334-8171

    Fax: (717) 334-8172

    Type: Location

  • 1701 TWIN SPRINGS RD

    HALETHORPE, MD 212273553

    Phone: (410) 737-5000

    Fax: (410) 737-5321

    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.

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 17325)

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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: 3779495858View full group profile

Reviews

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Frequently asked questions

How do I look up Unknown Individual by NPI?
Use NPI 1629078563 when you need to reference Unknown Individual in forms, claims, or directories.
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.
What does Unknown Individual treat or focus on?
Patients typically see Unknown Individual under the specialty Otolaryngology Physician. Clinical services aligned with this taxonomy classification.
Where does public data place Unknown Individual?
The snapshot lists Gettysburg, Pennsylvania for Unknown Individual; download NPPES for the complete set.
What if Gettysburg, Pennsylvania seems incomplete?
Street-level detail can be omitted — open the full address list for this NPI.

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