Unknown Individual – Obstetrics & Gynecology Physician, NPI 1053331165

Unknown Individual is a healthcare provider. based in Providence, Rhode Island. specializing in Obstetrics & Gynecology Physician. They hold a License No. MD03707 (RI). The NPI Number for Unknown Individual is 1053331165

Main info

Organization
Inactive
63 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1053331165
Phone
(401) 272-1550
Address
695 EDDY ST
Deactivation Date
26 February 2026

Doctor Profile

Medical School Name
TUFTS UNIVERSITY SCHOOL OF MEDICINE
Secondary Phone
4017240600
Graduation Year
1963 (63 years ago)
PAC ID
7214104876
Group Practice PAC ID
0042486649
Professional Enrollment ID
I20120123000292
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

  • 695, Eddy Street, Providence, Providence County, Rhode Island, 02903, United States

    SUITE 21

    PROVIDENCE, RI 029034941

    Phone: (401) 272-1550

    Fax: (401) 421-8792

    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)

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 02903)

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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: 0042486649View full group profile
NameSpecialtyState
-RI
O B S T E T R I C S/ G Y N E C O L O G YRI
Nurse PractitionerRI
O B S T E T R I C S/ G Y N E C O L O G YRI
O B S T E T R I C S/ G Y N E C O L O G YRI
O B S T E T R I C S/ G Y N E C O L O G YRI
O B S T E T R I C S/ G Y N E C O L O G YRI
O B S T E T R I C S/ G Y N E C O L O G YRI
O B S T E T R I C S/ G Y N E C O L O G YRI
O B S T E T R I C S/ G Y N E C O L O G YRI

Reviews

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Frequently asked questions

What identifier follows Unknown Individual across health systems?
The NPI 1053331165 uniquely identifies Unknown Individual in U.S. healthcare data.
Should I call the clinic if Unknown Individual is inactive here?
If Unknown Individual looks inactive here, cross-check state licensing and the clinic website.
What type of care does Unknown Individual provide?
Unknown Individual's profile centers on Obstetrics & Gynecology Physician. Clinical services aligned with this taxonomy classification.
Which community is linked to Unknown Individual?
Unknown Individual shows a connection to Providence, Rhode Island in registry-derived data.
Who maintains Unknown Individual's record?
Providers certify NPPES data; CMS hosts the public file you are viewing.

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