Fairfax Acne & Dermatology Services, PC

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

Legal business name

FAIRFAX ACNE & DERMATOLOGY SERVICES, PC

Practice address

1275 Wampanoag Trail
Ste. 6
East Providence, RI 02915-1217

Phone

(508) 404-4853

NPI assigned

Oct 31, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Diana L Fairfax, DCNPNPI 1023016953

Title

Owner

Phone

(508) 404-3853

Specialties & licenses 1

Addresses

Other names 1

• Fairfax Acne & Dermatology, PC Doing business as

Medicare fee-for-service enrollment

Enrolled in RI

Enrollment records 1

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Diana L Fairfax, NP

  • Nurse Practitioner
  • N. Attleboro, MA
  • NPI 1023016953

  RI

  Medicare reassignment Authorized official
• Alyssa Bishop Findley, M.D.

  • MOHS-Micrographic Surgery Physician
  • Riverside, RI
  • NPI 1437316676
  NPD
• Catherine Elizabeth Luz, MSN, APRN, FNP-C

  • Family Nurse Practitioner
  • Riverside, RI
  • NPI 1578080651
  NPD
• Nadia Katrina Rudman

  • Physician Assistant
  • Warwick, RI
  • NPI 1699409003
  NPD (past)
• Emily Catherine Ferullo, PHYSICIAN ASSISTANT

  • Physician Assistant
  • Boston, MA
  • NPI 1649014317
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1667174400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667174400000",
    "number": "1245947332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1275 WAMPANOAG TRAIL",
            "address_2": "STE. 6",
            "city": "EAST PROVIDENCE",
            "state": "RI",
            "postal_code": "029151217",
            "telephone_number": "508-404-4853"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1275 WAMPANOAG TRAIL",
            "address_2": "STE. 6",
            "city": "EAST PROVIDENCE",
            "state": "RI",
            "postal_code": "029151217",
            "telephone_number": "508-404-4853"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRFAX ACNE & DERMATOLOGY SERVICES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-31",
        "last_updated": "2022-10-31",
        "certification_date": "2022-10-29",
        "status": "A",
        "authorized_official_last_name": "FAIRFAX",
        "authorized_official_first_name": "DIANA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "508-404-3853",
        "authorized_official_credential": "DCNP"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fairfax Acne & Dermatology, PC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Nancy A Escobar, CD
• Nicole J Estrella, M.ED.
• Marylynn Elizabeth Everton, M.S., OTR/L
• Evolution Nutrition Inc.
• Eye Consultants of Rhode Island LTD.
• Beverly Fairhurst, M.A., LCMHC, LCDP
• Family Doctors Group, PC
• David S Farrell, MD
• Jessica Brett Farrell, M.D.
• Meghan Farrelly, LICSW

• Nurse Practitioner in East Providence, RI
• Providers in East Providence, RI by specialty
• Nurse Practitioner in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.