Unknown Individual – Dermatopathology Physician, NPI 1528045309

Unknown Individual is a healthcare provider. based in Boston, Massachusetts. specializing in Dermatopathology Physician. They hold a License No. 28329 (MA). The NPI Number for Unknown Individual is 1528045309

Main info

Organization
Inactive
65 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1528045309
Phone
(617) 264-5910
Address
41 AVENUE LOUIS PASTEUR
Deactivation Date
15 September 2022

Doctor Profile

Medical School Name
OTHER
Secondary Phone
6177325500
Graduation Year
1961 (65 years ago)
PAC ID
8325025562
Group Practice PAC ID
3870405988
Professional Enrollment ID
I20040706000649
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience24
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • Alumnae Hall, 41, Avenue Louis Pasteur, Roxbury, Boston, Suffolk County, Massachusetts, 02120, United States

    ALUMNAE HALL, ROOM 317

    BOSTON, MA 021155727

    Phone: (617) 264-5910

    Fax: (617) 264-3021

    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 02115)

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Provider's Procedures

Unknown Individual performs procedures in Dermatopathology Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
PATHOLOGYMA17003Destruction of 2-14 skin growths7219
PATHOLOGYMA88307Pathology examination of tissue using a microscope, moderately high complexity17736
PATHOLOGYMA88342Tissue or cell analysis by immunologic technique13640

Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 3870405988View full group profile
NameSpecialtyState
N E U R O S U R G E R YMD
-MA
Critical Care (Intensivists), Pulmonary DiseaseFL
Physician AssistantMA
N E U R O L O G YMA
Nurse PractitionerMA
Orthopedic SurgeryMA
Physician AssistantNH
Nurse PractitionerMA
P A T H O L O G YMA

Reviews

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Frequently asked questions

Can I verify Unknown Individual with an NPI only?
You can start verification with NPI 1528045309 for Unknown Individual, then check state licensing separately.
Why might Unknown Individual appear inactive while still practicing?
We display what the registry publishes: Unknown Individual appears inactive there.
What is Unknown Individual's specialty?
The listing groups Unknown Individual with Dermatopathology Physician. Clinical services aligned with this taxonomy classification.
Where is Unknown Individual based?
Unknown Individual is tied to Boston, Massachusetts in the data we show; additional addresses may exist on the full record.
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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