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EUTOPIA MEDICAL DERMATOLOGY AND AESTHETICS PLLC
NPI 1366262909
Dermatology in Fairfax, VA

Active since October 16, 2024CLIA 49D2316380 · Waiver
4211 FAIRFAX CORNER AVE E STE 225, FAIRFAX, VA 22030(703) 278-2473(703) 239-4857 Get Directions Write a Review

NPPES record last updated: February 10, 2026. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: May 23, 2025, Dec 3, 2024 (2 updates tracked since 2024).

About Eutopia Medical Dermatology And Aesthetics Pllc NPPES

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

EUTOPIA MEDICAL DERMATOLOGY AND AESTHETICS PLLC (NPI 1366262909) is a healthcare organization registered as a dermatology in Fairfax, Virginia and active in the NPI registry since October 2024. The organization holds a CLIA Waiver certificate valid through January 2, 2027 and lists Etsubdenk Mezemir Ajebo, Dermatologist, as its authorized official.

NPPES Registry Identity

NPI1366262909
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameEUTOPIA MEDICAL DERMATOLOGY AND AESTHETICS PLLC
Location Address4211 FAIRFAX CORNER AVE E STE 225Fairfax, VA 22030-8623
Mailing Address4211 Fairfax Corner Ave E Ste 225Fairfax, VA 22030-8623 · (703) 278-2473 · Fax (703) 239-4857
Phone(703) 278-2473
Fax(703) 239-4857
Organization SubpartNo
Authorized OfficialEtsubdenk Mezemir AjeboDermatologist · (703) 278-2473
Enumeration DateOctober 16, 2024
Last NPPES UpdateFebruary 10, 20262 updates tracked since enumeration
NPPES CertifiedFebruary 10, 2026
✔ NPI 1366262909 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
Definition
A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.
4211 FAIRFAX CORNER AVE E STE 225, Fairfax, VA 22030
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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)

Eutopia Medical Dermatology And Aesthetics Pllc 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 Eutopia Medical Dermatology And Aesthetics PLLC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Etsubdenk Ajebo, MD
Dermatology
NPI 1134788532
4211 FAIRFAX CORNER AVE E STE 225
Fairfax, VA 22030
(703) 278-2473
✔ PECOS✔ Accepts MedicareSame address

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

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 49D2316380

Eutopia Medical Dermatology & Aesthetics PLLC · Fairfax, VA
Active · expires Jan 2, 2027
CLIA Number49D2316380
Laboratory TypePhysician Office
Certificate Effective DateJanuary 3, 2025
Certificate Expiration DateJanuary 2, 2027
Laboratory DirectorEtsubdenk Ajebo
Laboratory Phone(703) 239-4857
Laboratory LocationEutopia Medical Dermatology & Aesthetics PLLC4211 Fairfax Corner Ave E Suite 225, Fairfax, VA 22030
CLIA data matches this NPI record on: Address
This certificate is issued to a laboratory to perform only waived tests.

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 Eutopia Medical Dermatology And Aesthetics PLLC's NPI number?

The NPI number for Eutopia Medical Dermatology And Aesthetics PLLC is 1366262909. It was assigned to this organization in the NPPES registry on October 16, 2024.

Where is Eutopia Medical Dermatology And Aesthetics PLLC located?

Eutopia Medical Dermatology And Aesthetics PLLC is located at 4211 Fairfax Corner Ave E Ste 225, Fairfax, VA 22030. The listed phone number is (703) 278-2473.

What is Eutopia Medical Dermatology And Aesthetics PLLC's specialty?

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

Is Eutopia Medical Dermatology And Aesthetics PLLC enrolled in Medicare?

Yes. Eutopia Medical Dermatology And Aesthetics PLLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Eutopia Medical Dermatology And Aesthetics PLLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Dermatology) reassigns their Medicare billing to Eutopia Medical Dermatology And Aesthetics PLLC. 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.

Does Eutopia Medical Dermatology And Aesthetics PLLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 49D2316380) is associated with this NPI, valid through January 2, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Eutopia Medical Dermatology And Aesthetics PLLC was last updated on February 10, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 months 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.