Unknown Individual – Family Medicine Physician, NPI 1124028642

Unknown Individual is a healthcare provider. based in Roanoke, Virginia. specializing in Family Medicine Physician. They hold a License No. 0101027837 (VA). The NPI Number for Unknown Individual is 1124028642

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1124028642
Phone
(540) 520-9856
Address
PO BOX 4127
Deactivation Date
19 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

  • PO BOX 4127

    ROANOKE, VA 240150127

    Phone: (540) 520-9856

    Fax: (540) 344-7154

    Type: Mailing

  • 4311, Appleton Avenue Northwest, West View, Roanoke, Salem (city), Virginia, 24017, United States

    ROANOKE, VA 240172111

    Phone: (540) 520-9856

    Fax: (540) 344-7154

    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 24015)

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Reviews

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Frequently asked questions

What is the 10-digit NPI for Unknown Individual?
Unknown Individual — NPI 1124028642 — is the standard way to identify this listing.
Why might Unknown Individual appear inactive while still practicing?
We display what the registry publishes: Unknown Individual appears inactive there.
What is Unknown Individual best known for clinically?
Directory data describes Unknown Individual with Family Medicine Physician. Clinical services aligned with this taxonomy classification.
What area does Unknown Individual serve?
Unknown Individual's listing highlights Roanoke, Virginia; more addresses can appear in NPPES.
Why does Unknown Individual have multiple addresses?
2 practice locations appear in the available data. Multiple addresses are common for hospital privileges, telehealth, or multi-site groups.

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