Unknown Individual – Obstetrics & Gynecology Physician, NPI 1164733580

Unknown Individual is a healthcare provider. based in Chesapeake, Virginia. specializing in Obstetrics & Gynecology Physician. They hold a License No. 0102203058 (VA). The NPI Number for Unknown Individual is 1164733580

Main info

Organization
Inactive
16 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1164733580
Phone
(757) 436-0167
Address
612 Kingsborough Sq
Deactivation Date
6 October 2023

Doctor Profile

Medical School Name
OTHER
Secondary Phone
4343745344
Graduation Year
2010 (16 years ago)
PAC ID
5496077661
Group Practice PAC ID
1254311558
Professional Enrollment ID
I20150209001018

Contacts

Secure Messaging
griddick500954@direct.UNC.nchie.net
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience23
Completeness85
Years active:0State licenses:2Other namesUpdated within 12 months

Provider Addresses for Unknown Individual

  • 612 Kingsborough Sq

    Suite 200

    Chesapeake, VA 233205041

    Phone: (757) 436-0167

    Fax: (757) 436-0236

    Type: Location

  • 2000 PERIMETER PARK DR STE 200

    MORRISVILLE, NC 275608442

    Phone:

    Type: Mailing

  • 522 S VAN BUREN RD

    EDEN, NC 272885019

    Phone: (336) 627-1117

    Fax: (336) 627-5502

    Type: Location

  • 612 KINGSBOROUGH SQ

    SUITE 200

    CHESAPEAKE, VA 233205041

    Phone: (757) 436-0167

    Fax: (757) 436-0236

    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.

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 23320)

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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: 1254311558View full group profile
NameSpecialtyState
DEBRA A COLLINS (FNP-BC)
Nurse PractitionerVA
DR. BRIAN LEE BEACHAM (MD)
General SurgeryVA
DR. PHILIP HOLZKNECHT (M.D.)
Sports Medicine, Orthopedic SurgeryVA
MICHAEL K KYLES (MD)
Orthopedic SurgeryVA
MRS. MICHELLE BENDER GIBSON (NP)
Nurse PractitionerVA
JEFFERSON IRVIN BALIN (M.D.)
Diagnostic RadiologyVA
YANING ZHANG (MD)
General SurgeryVA
JEAN MINIER (FNP-C)
-VA
ELMER C SAN PEDRO (MD)
Diagnostic RadiologyVA
MESFIN RESE SHIBESHI (DO)
Orthopedic SurgeryVA

Reviews

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Frequently asked questions

Is Unknown Individual listed with a National Provider Identifier?
Yes — Unknown Individual has NPI 1164733580 on file in the registry.
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 Obstetrics & Gynecology Physician. Clinical services aligned with this taxonomy classification.
What locale is associated with Unknown Individual?
Directory geography for Unknown Individual centers on Chesapeake, Virginia.
What does 5 location(s) imply?
5 practice locations appear in the available data.