Unknown Individual – Anatomic Pathology & Clinical Pathology Physician, NPI 1417957739

Anatomic Pathology & Clinical Pathology Physician

Unknown Individual is a healthcare provider. based in Falls church, Virginia. specializing in Anatomic Pathology & Clinical Pathology Physician. They hold a License No. 0101020816 (VA). The NPI Number for Unknown Individual is 1417957739

Main info

Organization

Inactive

Name

Unknown Individual

NPI

1417957739

Phone

(703) 776-2717

Address

3300 GALLOWS RD

Deactivation Date

18 September 2025

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

3300 GALLOWS RD
FALLS CHURCH, VA 220423307
Phone: (703) 776-2717
Type: Location
Fairfax Boulevard, Lord Fairfax Estates, Fairfax, Fairfax (city), Virginia, 20121, United States
SUITE 501
FAIRFAX, VA 22030
Phone:
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.

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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 22042)

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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 1417957739.

What dates should I check for Unknown Individual's activity?

We display what the registry publishes: Unknown Individual appears inactive there.

What taxonomy line describes Unknown Individual?

For research purposes, treat Unknown Individual as Anatomic Pathology & Clinical Pathology Physician in this dataset. Clinical services aligned with this taxonomy classification.

Where is Unknown Individual based?

Unknown Individual is tied to Falls Church, Virginia in the data we show; additional addresses may exist on the full record.

Why does Unknown Individual have multiple addresses?

2 practice locations appear in the available data. Multiple addresses are common for hospital privileges, telehealth, or multi-site groups.