Unknown Individual – Plastic Surgery Physician, NPI 1104817006

Unknown Individual is a healthcare provider. based in Boston, Massachusetts. specializing in Plastic Surgery Physician. They hold a License No. 28814 (MA). The NPI Number for Unknown Individual is 1104817006

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1104817006
Phone
(617) 267-0710
Address
170 COMMONWEALTH AVE
Deactivation Date
12 March 2026
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

  • The Boston Center, 170, Commonwealth Avenue, Back Bay, Boston, Suffolk County, Massachusetts, 02116, United States

    BOSTON, MA 021162704

    Phone: (617) 267-0710

    Fax: (617) 236-8704

    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 02116)

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Reviews

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Frequently asked questions

What NPI should I save for Unknown Individual?
Save NPI 1104817006 if you need a stable reference for Unknown Individual.
Is Unknown Individual's inactive status permanent?
An inactive NPI does not by itself prove someone stopped practicing — check other sources.
Can you summarize Unknown Individual's specialty in plain language?
Clinically, the directory lists Unknown Individual with Plastic Surgery Physician. Clinical services aligned with this taxonomy classification.
What location shows for Unknown Individual?
We surface Boston, Massachusetts for Unknown Individual based on available NPPES addresses.
Does Medicare enrollment show here?
Medicare enrollment screens are separate from the basic NPI extract shown here.

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