Unknown Individual – Dermatopathology Physician, NPI 1871562363

Unknown Individual is a healthcare provider. based in Chestnut hill, Massachusetts. specializing in Dermatopathology Physician. They hold a License No. 12747 (NH). The NPI Number for Unknown Individual is 1871562363

Main info

Organization
Inactive
38 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1871562363
Phone
Not provided
Address
349 COMMONWEALTH AVE
Deactivation Date
21 April 2021

Doctor Profile

Medical School Name
HARVARD MEDICAL SCHOOL
Secondary Phone
5082383774
Graduation Year
1988 (38 years ago)
PAC ID
0345271292
Group Practice PAC ID
4789767104
Professional Enrollment ID
I20050830000820
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience36
Completeness75
Years active:0State licenses:4Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • Chestnut Hill Avenue, Commonwealth Avenue, Cleveland Circle, Brighton, Boston, Suffolk County, Massachusetts, 02135, United States

    CHESTNUT HILL, MA 024671013

    Phone:

    Type: Mailing

  • 320 Needham Street, 320;322, Needham Street, Newton Upper Falls, Newton, Middlesex County, Massachusetts, 02464, United States

    SUITE 200

    NEWTON, MA 024641592

    Phone: (617) 969-4100

    Fax: (617) 969-3393

    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.

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 02467)

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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: 4789767104View full group profile
NameSpecialtyState
D E R M A T O L O G YMA
D E R M A T O L O G YMA
D E R M A T O L O G YCT
D E R M A T O L O G YMA
D E R M A T O L O G YMA
D E R M A T O L O G YMA
D E R M A T O L O G YMA
-MA
D E R M A T O L O G YMA
Plastic And Reconstructive SurgeryMA

Reviews

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Frequently asked questions

Where can patients find Unknown Individual's NPI?
You can confirm Unknown Individual with NPI 1871562363; it appears in the national provider directory.
What is the next step if Unknown Individual is inactive?
Treat inactive as a signal to verify Unknown Individual through official channels.
What field does Unknown Individual work in?
You can think of Unknown Individual as practicing within Dermatopathology Physician. Clinical services aligned with this taxonomy classification.
What location shows for Unknown Individual?
We surface Chestnut Hill, Massachusetts for Unknown Individual based on available NPPES addresses.
Is this NPI for an individual or an organization?
This listing corresponds to an Individual Provider.

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