Unknown Individual – Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician, NPI 1114009362

Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician

Unknown Individual is a healthcare provider. based in Charlottesville, Virginia. specializing in Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician. They hold a License No. 0101033864 (VA). The NPI Number for Unknown Individual is 1114009362

Main info

Organization

Inactive

46 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1114009362

Phone

Not provided

Address

PO BOX 9007

Deactivation Date

30 October 2025

Doctor Profile

Medical School Name

VIRGINIA COMMONWEALTH UNIVERSITY, SCHOOL OF MEDICINE

Secondary Phone

4349248129

Graduation Year

1980 (46 years ago)

PAC ID

5496764433

Group Practice PAC ID

4880590728

Professional Enrollment ID

I20141104001116

Contacts

Secure Messaging

ctribble252591@direct.healthsystem.virginia.edu

Data current as of

19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology

Experience37

Completeness85

Years active:0State licenses:3Other namesUpdated within 12 months

Loading map...

Provider Addresses for Unknown Individual

Charlottesville Post Office, 1155, Seminole Trail, Westfield, Charlottesville, Albemarle County, Virginia, 22906, United States
CHARLOTTESVILLE, VA 229069007
Phone:
Type: Mailing
University of Virginia Medical Center, 1215, Lee Street, Jefferson Park Avenue, Starr Hill, Charlottesville, Virginia, 22908, United States
CHARLOTTESVILLE, VA 229080001
Phone: (434) 243-1000
Fax: (434) 243-7551
Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

Loading prescription activity...

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 22906)

Loading plans...

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: 4880590728View full group profile

Name	Specialty	State
HEATHER STEVENS SPADER (MD)	N E U R O S U R G E R Y	VA
Unknown Individual	-	VA
FARNAZ M GAZONI (MD)	A N E S T H E S I O L O G Y	VA
AMBER N. INOFUENTES (M.D.)	Internal Medicine	VA
MR. REAGAN WILLIAMS	Physician Assistant	VA
DONALD J. DUDLEY (M.D.)	-	VA
WILLIAM G. WILSON (M.D.)	-	VA
EVAN JOEL KAUFMAN (O.D.)	O P T O M E T R Y	VA
ALLISON J. BECHTEL (M.D.)	-	VA
MEGAN E. KINGDON (NP)	-	VA

Reviews

All reviews are moderated before publication. Reviews reflect users' opinions; we do not verify the accuracy of individual reviews.

No reviews yet. Be the first to share your experience — your opinion helps families compare providers.

Frequently asked questions

Can I verify Unknown Individual with an NPI only?

You can start verification with NPI 1114009362 for Unknown Individual, then check state licensing separately.

Is Unknown Individual's NPI deactivated?

The extract indicates Unknown Individual is not in an active NPI state.

What taxonomy line describes Unknown Individual?

For research purposes, treat Unknown Individual as Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician in this dataset. Clinical services aligned with this taxonomy classification.

Where should I expect Unknown Individual on a map?

Expect Charlottesville, Virginia as a primary anchor for Unknown Individual unless the record lists multiple sites.

How many locations tie to this NPI?

2 practice locations appear in the available data.