FAIRFAX ACNE & DERMATOLOGY SERVICES, PC
NPI 1245947332
Nurse Practitioner in East Providence, RI

Q: What is Fairfax Acne & Dermatology Services, PC's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Active since October 31, 2022

1275 WAMPANOAG TRAIL, STE. 6, EAST PROVIDENCE, RI 02915(508) 404-4853 Get Directions Write a Review

NPPES record last updated: October 31, 2022. Verified against the NPPES registry weekly; last sync: October 18, 2026.

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About Fairfax Acne & Dermatology Services, Pc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

FAIRFAX ACNE & DERMATOLOGY SERVICES, PC (NPI 1245947332), doing business as Fairfax Acne & Dermatology, Pc, is a healthcare organization registered as a nurse practitioner in East Providence, Rhode Island and active in the NPI registry since October 2022. The organization lists Diana L Fairfax, Owner, as its authorized official.

NPPES Registry Identity

NPI1245947332

Entity TypeOrganization

Primary Taxonomy363L00000X

Legal Business NameFAIRFAX ACNE & DERMATOLOGY SERVICES, PC

Location Address1275 WAMPANOAG TRAIL, STE. 6East Providence, RI 02915-1217

Mailing Address1275 Wampanoag Trail, Ste. 6East Providence, RI 02915-1217 · (508) 404-4853

Phone(508) 404-4853

Organization SubpartNo

Authorized OfficialDiana L FairfaxOwner · (508) 404-3853

Enumeration DateOctober 31, 2022

NPPES CertifiedOctober 29, 2022

✔ NPI 1245947332 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363L00000X

Definition

(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.

1275 WAMPANOAG TRAIL, East Providence, RI 02915

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Other Names 1

Doing Business AsFairfax Acne & Dermatology, Pc

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Fairfax Acne & Dermatology Services, Pc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Fairfax Acne & Dermatology Services, PC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Diana Fairfax, NP

Nurse Practitioner

NPI 1023016953

153 E. WASHINGTON STREET
N. Attleboro, MA 02760

(508) 699-7546

✔ PECOS✔ Accepts Medicare13 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Fairfax Acne & Dermatology Services, PC's NPI number?

The NPI number for Fairfax Acne & Dermatology Services, PC is 1245947332. It was assigned to this organization in the NPPES registry on October 31, 2022. The provider is doing business as Fairfax Acne & Dermatology, PC.

Where is Fairfax Acne & Dermatology Services, PC located?

Fairfax Acne & Dermatology Services, PC is located at 1275 Wampanoag Trail Ste. 6, East Providence, RI 02915. The listed phone number is (508) 404-4853.

What is Fairfax Acne & Dermatology Services, PC's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Is Fairfax Acne & Dermatology Services, PC enrolled in Medicare?

Yes. Fairfax Acne & Dermatology Services, PC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Fairfax Acne & Dermatology Services, PC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Nurse Practitioner) reassigns their Medicare billing to Fairfax Acne & Dermatology Services, PC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Fairfax Acne & Dermatology Services, PC was last updated on October 31, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.