Unknown Individual – Clinical Genetics (M.D.) Physician, NPI 1255381794

Unknown Individual is a healthcare provider. based in Richmond, Virginia. specializing in Clinical Genetics (M.D.) Physician. They hold a License No. E5829 (TX). The NPI Number for Unknown Individual is 1255381794

Main info

Organization
Inactive
56 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1255381794
Phone
(804) 628-4517
Address
1101 E MARSHALL ST
Deactivation Date
23 April 2026

Doctor Profile

Medical School Name
UNIVERSITY OF ILLINOIS COLLEGE OF MED (CHI/PEOR/ROCK/CHM-URB)
Secondary Phone
8043646641
Graduation Year
1970 (56 years ago)
PAC ID
2365431442
Group Practice PAC ID
4385542117
Professional Enrollment ID
I20120914000750
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience19
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 1101, East Marshall Street, Shockoe Slip, Richmond, Richmond City, Virginia, 23298, United States

    PO 980033

    RICHMOND, VA 232985048

    Phone: (804) 628-4517

    Fax: (804) 827-1124

    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 23298)

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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: 4385542117View full group profile
NameSpecialtyState
Internal MedicineVA
-VA
Nurse PractitionerVA
Orthopedic SurgeryVA
O T O L A R Y N G O L O G YVA
Diagnostic RadiologyVA
Nurse PractitionerVA
Qualified AudiologistVA
Radiation OncologyVA
O T O L A R Y N G O L O G YVA

Reviews

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Frequently asked questions

What number should I use to identify Unknown Individual for billing?
Administrative and clinical systems typically use NPI 1255381794 for Unknown Individual.
What should I verify if Unknown Individual is listed inactive?
If Unknown Individual looks inactive here, cross-check state licensing and the clinic website.
What services align with Unknown Individual's listing?
Unknown Individual's public classification highlights Clinical Genetics (M.D.) Physician. Clinical services aligned with this taxonomy classification.
Which community is linked to Unknown Individual?
Unknown Individual shows a connection to Richmond, Virginia in registry-derived data.
Can I verify credentials using only NPI?
NPI confirms identity in the directory; licensure and board certification require separate checks.

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