Unknown Individual – Hematology & Oncology Physician, NPI 1710092135

Unknown Individual is a healthcare provider. based in Philadelphia, Pennsylvania. specializing in Hematology & Oncology Physician. They hold a License No. MD044995L (PA). The NPI Number for Unknown Individual is 1710092135

Main info

Organization
Inactive
45 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1710092135
Phone
(215) 612-5250
Address
3998 RED LION RD
Deactivation Date
7 February 2024

Doctor Profile

Medical School Name
OTHER
Secondary Phone
2156248138
Graduation Year
1981 (45 years ago)
PAC ID
1658447404
Group Practice PAC ID
0941229017
Professional Enrollment ID
I20100322000579
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

  • 3998, Red Lion Road, Crestmont Farms, Philadelphia, Philadelphia County, Pennsylvania, 19114, United States

    SUITE 130

    PHILADELPHIA, PA 191141436

    Phone: (215) 612-5250

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 1 Open Payments records for all available years, with a total value of $17.

Total Amount is formed as General ($17) + Research ($0) + Ownership ($0) = $17.

Last reported payment date: 2023-06-29 • Largest payer in this snapshot: Pharmacyclics LLC, an AbbVie Company ($17).

Total Amount

$17

General + Research + Ownership

Payments

1

Total payment records

General Amount

$17

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2023-06-29

Latest reported date

Top Companies

Largest payers in this snapshot

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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 19114)

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Provider's Procedures

Unknown Individual performs procedures in Hematology & Oncology Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
HEMATOLOGY/ONCOLOGYPA96367Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour24421
HEMATOLOGY/ONCOLOGYPA96375Injection of different drug or substance into a vein for therapy, diagnosis, or prevention21618

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: 0941229017View full group profile

Reviews

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Frequently asked questions

What is the 10-digit NPI for Unknown Individual?
Unknown Individual — NPI 1710092135 — is the standard way to identify this listing.
Why might Unknown Individual appear inactive while still practicing?
We display what the registry publishes: Unknown Individual appears inactive there.
What taxonomy line describes Unknown Individual?
For research purposes, treat Unknown Individual as Hematology & Oncology Physician in this dataset. Clinical services aligned with this taxonomy classification.
Where should I expect Unknown Individual on a map?
Expect Philadelphia, Pennsylvania as a primary anchor for Unknown Individual unless the record lists multiple sites.
Why does Unknown Individual have multiple addresses?
2 practice locations appear in the available data. Multiple addresses are common for hospital privileges, telehealth, or multi-site groups.

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