Unknown Individual – Otolaryngology Physician, NPI 1790748358

Unknown Individual is a healthcare provider. based in Woodstock, Vermont. specializing in Otolaryngology Physician. They hold a License No. MD00017402 (WA). The NPI Number for Unknown Individual is 1790748358

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1790748358
Phone
(802) 457-7116
Address
22 PROSPECT ST
Deactivation Date
19 June 2025
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

  • 22, Prospect Street, Woodstock Village Historic District, Woodstock Village, Woodstock, Windsor County, Vermont, 05091, United States

    WOODSTOCK, VT 050911286

    Phone: (802) 457-7116

    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 05091)

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Reviews

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Frequently asked questions

How is Unknown Individual identified in CMS data?
CMS-hosted NPPES data lists Unknown Individual with NPI 1790748358.
Is Unknown Individual excluded from programs when inactive?
The public NPI listing for Unknown Individual is not currently active; confirm directly with the practice or licensing boards.
What is Unknown Individual best known for clinically?
Directory data describes Unknown Individual with Otolaryngology Physician. Clinical services aligned with this taxonomy classification.
Does Unknown Individual list a practice location?
Patients near Woodstock, Vermont 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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