Unknown Individual – Hematology & Oncology Physician, NPI 1063417707

Hematology & Oncology Physician

Unknown Individual is a healthcare provider. based in Norfolk, Virginia. specializing in Hematology & Oncology Physician. They hold a License No. 0101236368 (VA). The NPI Number for Unknown Individual is 1063417707

Main info

Organization

Inactive

32 Years Of Experience

Accepts Medicare Assignment

Name

Unknown Individual

NPI

1063417707

Phone

(757) 213-5700

Address

5900 LAKE WRIGHT DR

Deactivation Date

4 December 2025

Doctor Profile

Medical School Name

OTHER

Secondary Phone

7575494403

Graduation Year

1994 (32 years ago)

PAC ID

6103875133

Group Practice PAC ID

2769395797

Professional Enrollment ID

I20050118000313

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

5900, Lake Wright Drive, Camden Heights, Norfolk, Virginia, 23502, United States
NORFOLK, VA 235021866
Phone: (757) 213-5700
Fax: (757) 213-5701
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.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCS	Description	Services	Beneficiaries	Medicare allowed
J9271	Injection, pembrolizumab, 1 mg	9,400	11	$0
J9025	Injection, azacitidine, 1 mg	5,200	13	$0
85025	Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count	2,616	901	$0
J1100	Injection, dexamethasone sodium phosphate, 1 mg	1,606	35	$0
36415	Insertion of needle into vein for collection of blood sample	1,090	540	$0

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Insurance plans in this area (ZIP 23502)

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Provider's Procedures

Unknown Individual performs procedures in Hematology & Oncology Physician. See the list of HCPCS codes below.

Specialty	Practice State	HCPCS Code	Description	Service Count	Beneficiary Count
HEMATOLOGY/ONCOLOGY	VA	96375	Injection of different drug or substance into a vein for therapy, diagnosis, or prevention	278	76
HEMATOLOGY/ONCOLOGY	VA	96415	Infusion of chemotherapy into a vein	117	24

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: 2769395797View full group profile

Name	Specialty	State
SHELBY RAE BURTON	Physician Assistant	CA
LISA A EVERITT (PA)	Physician Assistant	VA
GRACE VICTORIA PERRY (RN MSN APN-C OCN)	Nurse Practitioner	NJ
ERIK JON RICHARDSON (PA)	Physician Assistant	VA
Unknown Individual	-	VA
CHRISTINA MEGAN BERTOLI (F.N.P.)	Nurse Practitioner	VA
BRUCE W BOOTH (MD)	-	VA
DR. SNEHAL A. DAMLE (M.D)	H E M A T O L O G Y/ O N C O L O G Y	VA
COURTNEY ANNE HASTINGS (MSN, FNP)	Nurse Practitioner	VA
SUZANNE F MILLER (PA)	Physician Assistant	GA

Reviews

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Frequently asked questions

Does Unknown Individual have a public NPI I can cite?

Public records show Unknown Individual under NPI 1063417707.

Should I call the clinic if Unknown Individual is inactive here?

If Unknown Individual looks inactive here, cross-check state licensing and the clinic website.

What does the directory say Unknown Individual does?

Insurance directories may phrase it differently, but here Unknown Individual maps to Hematology & Oncology Physician. Clinical services aligned with this taxonomy classification.

Is Unknown Individual tied to Norfolk, Virginia?

If you are local to Norfolk, Virginia, Unknown Individual may be relevant to your search.

Why is information missing for Unknown Individual?

Providers choose how much contact data to publish. Missing fields do not mean the profile is fake.