Unknown Individual – Child & Adolescent Psychiatry Physician, NPI 1588620777

Unknown Individual is a healthcare provider. based in Winchester, Virginia. specializing in Child & Adolescent Psychiatry Physician. They hold a License No. 0101047738 (VA). The NPI Number for Unknown Individual is 1588620777

Main info

Organization
Inactive
58 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1588620777
Phone
(540) 955-1710
Address
200 N WASHINGTON ST
Deactivation Date
7 October 2022

Doctor Profile

Medical School Name
WEST VIRGINIA UNIVERSITY SCHOOL OF MEDICINE
Secondary Phone
5406362931
Graduation Year
1968 (58 years ago)
PAC ID
0143231936
Group Practice PAC ID
2769371251
Professional Enrollment ID
I20060508000797
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

  • 200, North Washington Street, Winchester, Virginia, 22601, United States

    WINCHESTER, VA 226013912

    Phone: (540) 955-1710

    Fax: (540) 955-5096

    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 22601)

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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: 2769371251View full group profile
NameSpecialtyState
-VA
P S Y C H I A T R YMD
Mental Health CounselorVA
Mental Health CounselorVA
-TN
Clinical Social WorkerVA
-FL
Mental Health CounselorVA
Nurse PractitionerVA
Mental Health CounselorAL

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 1588620777 in the public NPI dataset.
Why might Unknown Individual appear inactive while still practicing?
We display what the registry publishes: Unknown Individual appears inactive there.
What healthcare role does Unknown Individual hold?
Scheduling teams often label Unknown Individual under Child & Adolescent Psychiatry Physician. Clinical services aligned with this taxonomy classification.
Does Unknown Individual list a practice location?
Patients near Winchester, Virginia may find Unknown Individual in results; validate coverage separately.
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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