Unknown Individual – Psychiatry Physician, NPI 1083675482

Unknown Individual is a healthcare provider. based in Alexandria, Virginia. specializing in Psychiatry Physician. They hold a License No. 0101024043 (VA). The NPI Number for Unknown Individual is 1083675482

Main info

Organization
Inactive
61 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1083675482
Phone
Not provided
Address
9400 FERRY LANDING CT
Deactivation Date
20 February 2025

Doctor Profile

Medical School Name
PERELMAN SCHOOL OF MED AT THE UNIVERSITY OF PENNSYLVANIA
Secondary Phone
7039604901
Graduation Year
1965 (61 years ago)
PAC ID
6507921533
Group Practice PAC ID
3870658800
Professional Enrollment ID
I20090209000103
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

Provider Addresses for Unknown Individual

  • 9400 FERRY LANDING CT

    ALEXANDRIA, VA 223093147

    Phone:

    Type: Mailing

  • 2059 HUNTINGTON AVE

    #108

    ALEXANDRIA, VA 223031636

    Phone: (703) 960-4900

    Fax: (703) 960-4952

    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 22309)

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Provider's Procedures

Unknown Individual performs procedures in Psychiatry Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
PSYCHIATRYVA90836Psychotherapy, 45 minutes with patient and/or family member28648

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: 3870658800View full group profile
NameSpecialtyState
-VA

Reviews

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Frequently asked questions

Can I cross-check Unknown Individual using NPI 1083675482?
NPI 1083675482 belongs to Unknown Individual; compare other details if you need extra assurance.
Is Unknown Individual still active if the NPI shows inactive?
NPPES shows Unknown Individual as inactive; dates on the record explain the timeline when available.
What area of care is associated with Unknown Individual?
Unknown Individual's record emphasizes Psychiatry Physician. Clinical services aligned with this taxonomy classification.
Is Unknown Individual associated with Alexandria?
Public fields place Unknown Individual around Alexandria, Virginia. Always confirm the exact site before visiting.
Can I trust this NPI listing for Unknown Individual?
The listing is sourced from the national NPI registry. If something looks off, compare with NPPES and the clinic's website.

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