Unknown Individual – Anatomic Pathology & Clinical Pathology Physician, NPI 1073504502

Unknown Individual is a healthcare provider. based in Burlington, Massachusetts. specializing in Anatomic Pathology & Clinical Pathology Physician. They hold a License No. 72527 (MA). The NPI Number for Unknown Individual is 1073504502

Main info

Organization
Inactive
40 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1073504502
Phone
(781) 744-8000
Address
41 Mall Rd
Deactivation Date
22 February 2023

Doctor Profile

Medical School Name
RUTGERS R W JOHNSON MEDICAL SCHOOL (CAM/NEW BRUNS/PISC)
Secondary Phone
6174995064
Graduation Year
1986 (40 years ago)
PAC ID
6002854601
Group Practice PAC ID
1759479744
Professional Enrollment ID
I20050425000069
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

Provider Addresses for Unknown Individual

  • 41 Mall Rd

    Burlington, MA 018052696

    Phone: (781) 744-8000

    Type: Location

  • Charlestown Post Office (mobile), Pattern Close, St Austell Bay, Charlestown, Cornwall, England, PL25 3FQ, United Kingdom

    MASS GENERAL PHYSICIAN ORGANIZATION

    CHARLESTOWN, MA 021299142

    Phone: (617) 724-0287

    Fax: (617) 726-2894

    Type: Mailing

  • Massachusetts General Hospital, 55, Fruit Street, Beacon Hill, Boston, Suffolk County, Massachusetts, 02114, United States

    PATHOLOGY ASSOCIATES WRN 2

    BOSTON, MA 021142696

    Phone: (617) 726-2967

    Fax: (617) 726-2967

    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.

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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 01805)

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Provider's Procedures

Unknown Individual performs procedures in Anatomic Pathology & Clinical Pathology Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
PATHOLOGYMA88304Pathology examination of tissue using a microscope, moderately low complexity7272
PATHOLOGYMA88307Pathology examination of tissue using a microscope, moderately high complexity12897

Reviews

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Frequently asked questions

Can I verify Unknown Individual with an NPI only?
You can start verification with NPI 1073504502 for Unknown Individual, then check state licensing separately.
What dates should I check for Unknown Individual's activity?
We display what the registry publishes: Unknown Individual appears inactive there.
What is Unknown Individual's primary classification?
Anatomic Pathology & Clinical Pathology Physician is the headline specialty for Unknown Individual here. Clinical services aligned with this taxonomy classification.
Where is Unknown Individual based?
Unknown Individual is tied to Burlington, Massachusetts in the data we show; additional addresses may exist on the full record.
Is specialty guaranteed by NPI alone?
Taxonomy selections describe intent; scope of practice still follows state law.

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