Unknown Individual – Specialist, NPI 1629046180

Unknown Individual is a healthcare provider. based in Fairfax, Virginia. specializing in Specialist. They hold a License No. 0101041648 (VA). The NPI Number for Unknown Individual is 1629046180

Main info

Organization
Inactive
47 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1629046180
Phone
(571) 472-4100
Address
3580 Joseph Siewick Dr Ste 206
Deactivation Date
25 January 2022

Doctor Profile

Medical School Name
OTHER
Secondary Phone
-
Graduation Year
1979 (47 years ago)
PAC ID
1456483114
Professional Enrollment ID
I20100715000232
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

  • 3580 Joseph Siewick Dr Ste 206

    Fairfax, VA 220331764

    Phone: (571) 472-4100

    Fax: (571) 472-4101

    Type: Location

  • 3300 Gallows Rd

    Falls Church, VA 220423307

    Phone: (703) 776-4001

    Fax: (703) 776-7113

    Type: Location

  • 1500 N Beauregard St Ste 300

    Alexandria, VA 223111715

    Phone: (571) 472-4100

    Fax: (571) 472-4101

    Type: Location

  • 1916, Opitz Boulevard, Featherstone, Woodbridge, Prince William County, Virginia, 22191, United States

    WOODBRIDGE, VA 221913304

    Phone: (703) 551-4113

    Fax: (703) 491-1019

    Type: Mailing

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 22033)

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Provider's Procedures

Unknown Individual performs procedures in Specialist. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
NEUROSURGERYVA63048Partial removal of spine bone with release of spinal cord and/or nerves7323

Reviews

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Frequently asked questions

How is Unknown Individual identified in CMS data?
CMS-hosted NPPES data lists Unknown Individual with NPI 1629046180.
Is Unknown Individual's NPI deactivated?
The extract indicates Unknown Individual is not in an active NPI state.
What is Unknown Individual's specialty?
The listing groups Unknown Individual with Other Service Providers. Clinical services aligned with this taxonomy classification.
Where should I expect Unknown Individual on a map?
Expect Fairfax, Virginia as a primary anchor for Unknown Individual unless the record lists multiple sites.
Is the information about Unknown Individual up to date?
Data updates when providers file changes in NPPES — treat critical facts as "verify if unsure."

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