Unknown Individual – Neurology Physician, NPI 1396774683

Unknown Individual is a healthcare provider. based in Fredericksburg, Virginia. specializing in Neurology Physician. They hold a License No. 0101053248 (VA). The NPI Number for Unknown Individual is 1396774683

Main info

Organization
Inactive
47 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1396774683
Phone
(540) 899-2900
Address
220 EXECUTIVE CENTER PKWY
Deactivation Date
20 November 2025

Doctor Profile

Medical School Name
UNIVERSITY OF IOWA, RJ & L CARVER COLLEGE OF MEDICINE
Secondary Phone
5408992900
Graduation Year
1979 (47 years ago)
PAC ID
1153421581
Group Practice PAC ID
2769546530
Professional Enrollment ID
I20100423000203
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

  • Executive Center Parkway, Normandy Village, Fredericksburg, Virginia, 22402, United States

    FREDERICKSBURG, VA 224013107

    Phone: (540) 899-2900

    Fax: (540) 899-3395

    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 22401)

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Provider's Procedures

Unknown Individual performs procedures in Neurology Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
NEUROLOGYVA95910Nerve transmission studies, 7-8 studies6361

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: 2769546530View full group profile
NameSpecialtyState
Certified Nurse Midwife (Cnm)VA
Physical Therapist In Private PracticeVA
Physician AssistantVA
-VA
Internal MedicineVA
Family PracticeVA
-OH
-VA
Physical Therapist In Private PracticeMD
Physical Therapist In Private PracticeVA

Reviews

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Frequently asked questions

What is Unknown Individual's NPI number?
Unknown Individual's NPI is 1396774683 — the number used across U.S. healthcare to identify this provider.
Who updates status for Unknown Individual?
NPPES shows Unknown Individual as inactive; dates on the record explain the timeline when available.
What expertise is attributed to Unknown Individual?
Unknown Individual's specialty line reads Neurology Physician. Clinical services aligned with this taxonomy classification.
Is Unknown Individual located near Fredericksburg?
Unknown Individual currently maps to Fredericksburg, Virginia in this extract.
When was this NPI issued?
Enumeration for Unknown Individual is noted as not shown in this record where the registry provides it.

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