Fairlawn Dermatology, LLC

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

8780 Issued in OH

Legal business name

FAIRLAWN DERMATOLOGY, LLC

Practice address

55 Merz Blvd
Suite a
Fairlawn, OH 44333-2895

Phone

(330) 864-9000

Fax

(330) 864-9004

NPI assigned

Jul 12, 2006

Organization subpart

No

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

Authorized official

Name

Valerie W Fuller, D.O.NPI 1275503724

Title

Physician

Phone

(330) 864-9000

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 6

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

• Valerie W. Fuller, D.O.

  • Dermatology Physician
  • Fairlawn, OH
  • NPI 1275503724
  Medicare reassignment Care Compare group NPD Authorized official
• Kimberly Anne Beyer, DNP, CNP

  • Family Nurse Practitioner
  • Fairlawn, OH
  • NPI 1285814046
  Medicare reassignment Care Compare group NPD
• Lindsay Chappell, C.N.P.

  • Primary Care Nurse Practitioner
  • Fairlawn, OH
  • NPI 1992112312
  Medicare reassignment Care Compare group NPD
• Alex T Meiser, NP-C

  • Nurse Practitioner
  • Fairlawn, OH
  • NPI 1962054585
  Medicare reassignment Care Compare group NPD
• Nathaniel Charter Cevasco, M.D.

  • Dermatology Physician
  • Broadview HTS, OH
  • NPI 1477746881
  NPD (past)
• Gary D Lichten, MD

  • Dermatology Physician
  • Fairlawn, OH
  • NPI 1174517932
  NPD (past)

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

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1361145600000",
    "number": "1356376917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 MERZ BLVD",
            "address_2": "SUITE A",
            "city": "FAIRLAWN",
            "state": "OH",
            "postal_code": "443332895",
            "telephone_number": "330-864-9000",
            "fax_number": "330-864-9004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 MERZ BLVD",
            "address_2": "SUITE A",
            "city": "FAIRLAWN",
            "state": "OH",
            "postal_code": "443332895",
            "telephone_number": "330-864-9000",
            "fax_number": "330-864-9004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRLAWN DERMATOLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-12",
        "last_updated": "2013-02-18",
        "status": "A",
        "authorized_official_last_name": "FULLER",
        "authorized_official_first_name": "VALERIE",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "330-864-9000",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "OH",
            "license": "8780",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chad Edward Everson, PTA
• Gabrielle Elizabeth Faggella, M.S.S.A., L.I.S.W.-S
• Shawn Michael Fahey, MS ATC
• Stephanie Raye Fain-Jones, COTA/L
• Abigail Elizabeth Fairbanks
• Fairlawn Family Practice Inc.
• Fairlawn Foot & Ankle Clinic Inc
• Fairlawn Healthcare LLC
• Fairlawn Opco, LLC
• Fairlawn Opco, LLC

• Medical Specialty Clinic/Center in Fairlawn, OH
• Providers in Fairlawn, OH by specialty
• Medical Specialty Clinic/Center in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.