Unknown Individual – Dermatology Physician, NPI 1114967643

Unknown Individual is a healthcare provider. based in Fairhaven, Massachusetts. specializing in Dermatology Physician. They hold a License No. 34188 (MA). The NPI Number for Unknown Individual is 1114967643

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1114967643
Phone
(508) 973-2000
Address
200 MILL ROAD
Deactivation Date
4 March 2022
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, Mill Road, Nasketucket, Fairhaven, Bristol County, Massachusetts, 02719, United States

    SUITE 180

    FAIRHAVEN, MA 027195252

    Phone: (508) 973-2000

    Fax: (508) 973-2001

    Type: Mailing

  • Truesdale Clinic, 1030, President Avenue, Fall River, Bristol County, Massachusetts, 02720, United States

    SUITE 107

    FALL RIVER, MA 02720

    Phone: (508) 676-3411

    Fax: (508) 235-6405

    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.

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 02719)

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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 1114967643.
Does inactive mean outdated data for Unknown Individual?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.
How should patients interpret Unknown Individual's specialty?
The extract shows Dermatology Physician for Unknown Individual. Clinical services aligned with this taxonomy classification.
Which community is linked to Unknown Individual?
Unknown Individual shows a connection to Fairhaven, Massachusetts in registry-derived data.
Why is information missing for Unknown Individual?
Providers choose how much contact data to publish. Missing fields do not mean the profile is fake.

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