Unknown Individual – Otology & Neurotology Physician, NPI 1740213891

Unknown Individual is a healthcare provider. based in Vienna, Virginia. specializing in Otology & Neurotology Physician. They hold a License No. D44922 (MD). The NPI Number for Unknown Individual is 1740213891

Main info

Organization
Inactive
55 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1740213891
Phone
(703) 356-1465
Address
201 PARK ST SE
Deactivation Date
7 June 2023

Doctor Profile

Medical School Name
JEFFERSON MEDICAL COLLEGE OF THOMAS JEFFERSON UNIVERSITY
Secondary Phone
7033561465
Graduation Year
1971 (55 years ago)
PAC ID
2163615055
Professional Enrollment ID
I20101025000088
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience23
Completeness75
Years active:0State licenses:2Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • Park Street Southeast, Vienna, Fairfax (city), Virginia, 22180-5605, United States

    VIENNA, VA 221804644

    Phone: (703) 356-1465

    Fax: (301) 983-5856

    Type: Location

  • 8204, Hackamore Drive, River Falls, Potomac, Montgomery County, Maryland, 20854, United States

    POTOMAC, MD 208543874

    Phone: (301) 299-7096

    Fax: (301) 983-5856

    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.

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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.

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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 22180)

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Reviews

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Frequently asked questions

What is Unknown Individual's NPI number?
Unknown Individual's NPI is 1740213891 — the number used across U.S. healthcare to identify this provider.
Is inactive the same as retired for Unknown Individual?
Inactive registry status can reflect deactivation, consolidation, or data lag.
What kind of doctor is Unknown Individual?
Unknown Individual is associated with Otology & Neurotology Physician in the directory — Clinical services aligned with this taxonomy classification.
Is Unknown Individual associated with Vienna?
Public fields place Unknown Individual around Vienna, Virginia. Always confirm the exact site before visiting.
Does inactive status remove historical data?
Historical rows can remain visible after status changes — read the dates carefully.