Unknown Individual – Psychiatry Physician, NPI 1508952904

Psychiatry Physician

Unknown Individual is a healthcare provider. based in Henrico, Virginia. specializing in Psychiatry Physician. They hold a License No. 0101237765 (VA). The NPI Number for Unknown Individual is 1508952904

Main info

Organization

Inactive

24 Years Of Experience

Name

Unknown Individual

NPI

1508952904

Phone

(804) 740-1651

Address

2416 BRIDGEHAVEN TER

Deactivation Date

19 June 2024

Doctor Profile

Medical School Name

GEORGETOWN UNIVERSITY SCHOOL OF MEDICINE

Secondary Phone

7032897560

Graduation Year

2002 (24 years ago)

PAC ID

6507966389

Group Practice PAC ID

2466351093

Professional Enrollment ID

I20070709000442

Contacts

Secure Messaging

rnene190367@soc.inova.org

Data current as of

19 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

2416, Bridgehaven Terrace, Steveston, Short Pump, Henrico County, Virginia, 23233, United States
HENRICO, VA 232332414
Phone: (804) 740-1651
Type: Mailing
3300 GALLOWS RD
FALLS CHURCH, VA 220423307
Phone: (703) 776-4001
Fax: (703) 776-7113
Type: Mailing
2305 N Parham Rd
Suite 3
Richmond, VA 232293156
Phone: (804) 270-1124
Fax: (804) 270-2090
Type: Location
Virginia Tech - Richmond Center, 2810, North Parham Road, English Hills, Henrico County, Virginia, 23294, United States
SUITE 3
RICHMOND, VA 232293156
Phone: (804) 270-1124
Fax: (804) 270-2090
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.

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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 23233)

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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: 2466351093View full group profile

Name	Specialty	State
LAURA ANNE CINSKI (M.D.)	N E U R O L O G Y	HI
SANDHYA RAMANATHAN PANCH (M.D.)	H E M A T O L O G Y	WA
CAROL GAVIN (PMHNP)	-	VIR
DR. MICHAEL MAITLAND (M.D., PH.D.)	-	IL
ROBERT B STINGER (MD)	Orthopedic Surgery	VA
DR. JOHN L ALBRIGO (MD)	-	VA
ELISE L. BERMAN (MD)	Diagnostic Radiology	VA
JILL BIANCA WATRAS (M.D.)	General Surgery	CT
Unknown Individual	-	VA
SIDHARTHA CHANDELA (MD)	N E U R O S U R G E R Y	VA