Unknown Individual – Pediatrics Physician, NPI 1104813062

Unknown Individual is a healthcare provider. based in Salem, Massachusetts. specializing in Pediatrics Physician. They hold a License No. 45728 (MA). The NPI Number for Unknown Individual is 1104813062

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1104813062
Phone
(978) 745-3050
Address
72 HIGHLAND AVE
Deactivation Date
14 January 2021
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

  • 72, Highland Avenue, Federal Street District, Salem, Essex County, Massachusetts, 01970, United States

    SALEM, MA 019702738

    Phone: (978) 745-3050

    Fax: (978) 745-7014

    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.

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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 01970)

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Reviews

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Frequently asked questions

What is the registry number for Unknown Individual?
The registry entry for Unknown Individual shows NPI 1104813062.
Does inactive mean outdated data for Unknown Individual?
Inactive status means the NPI record is not marked active in the public file — verify before making care decisions.
What type of care does Unknown Individual provide?
Unknown Individual's profile centers on Pediatrics Physician. Clinical services aligned with this taxonomy classification.
What city is tied to Unknown Individual?
The directory associates Unknown Individual with Salem, Massachusetts. Check all listed addresses for suites or satellite offices.
Who maintains Unknown Individual's record?
Providers certify NPPES data; CMS hosts the public file you are viewing.

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