Unknown Individual – Dermatology Physician, NPI 1356309736

Unknown Individual is a healthcare provider. based in Virginia beach, Virginia. specializing in Dermatology Physician. They hold a License No. 0101047471 (VA). The NPI Number for Unknown Individual is 1356309736

Main info

Organization
Inactive
44 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1356309736
Phone
(757) 333-8001
Address
1157 FIRST COLONIAL RD STE 300
Deactivation Date
21 September 2021

Doctor Profile

Medical School Name
JEFFERSON MEDICAL COLLEGE OF THOMAS JEFFERSON UNIVERSITY
Secondary Phone
2523315869
Graduation Year
1982 (44 years ago)
PAC ID
4183510308
Group Practice PAC ID
9335338029
Professional Enrollment ID
I20091005000332

Contacts

Secure Messaging
Tompskj@tidewaterskincare.ema.direct.md
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness85
Years active:0State licenses:1Other namesUpdated within 12 months

Provider Addresses for Unknown Individual

  • 1157 FIRST COLONIAL RD STE 300

    VIRGINIA BEACH, VA 234542432

    Phone: (757) 333-8001

    Fax: (757) 333-8002

    Type: Mailing

  • 2206 Executive Dr Ste F

    Hampton, VA 236662583

    Phone: (757) 825-1440

    Fax: (757) 825-1587

    Type: Location

  • 5249 Providence Rd

    Virginia Beach, VA 234644201

    Phone: (757) 467-3900

    Fax: (757) 467-7800

    Type: Location

  • 5589 N Croatan Hwy

    Kitty Hawk, NC 279493996

    Phone: (252) 715-0610

    Fax: (252) 715-0612

    Type: Location

  • 4711 S Croatan Hwy Ste 6B

    Nags Head, NC 279598997

    Phone: (252) 441-0515

    Fax: (252) 441-0531

    Type: Location

  • 1134 N Road St Ste 3

    Elizabeth City, NC 279093365

    Phone: (252) 331-5869

    Fax: (252) 331-5906

    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 23454)

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Provider's Procedures

Unknown Individual performs procedures in Dermatology Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
DERMATOLOGYVA17003Destruction of 2-14 skin growths4530642
DERMATOLOGYVA88307Pathology examination of tissue using a microscope, moderately high complexity1467853

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: 9335338029View full group profile
NameSpecialtyState
-VA

Reviews

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Frequently asked questions

Can I use this page to confirm Unknown Individual's NPI?
Yes. Unknown Individual is listed with NPI 1356309736 in the public NPI dataset.
Is Unknown Individual's NPI deactivated?
The extract indicates Unknown Individual is not in an active NPI state.
What healthcare role does Unknown Individual hold?
Scheduling teams often label Unknown Individual under Dermatology Physician. Clinical services aligned with this taxonomy classification.
Where is Unknown Individual based?
Unknown Individual is tied to Virginia Beach, Virginia in the data we show; additional addresses may exist on the full record.
What does 'Individual Provider' mean on this profile?
Entity type tells you whether the number belongs to a person or an organization.

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