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General NPI Number Information
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NPI Number | 1366262909
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Entity Type | Organization
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Legal Business Name | EUTOPIA MEDICAL DERMATOLOGY AND AESTHETICS PLLC
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Dates
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Enumeration Date | 10/16/2024
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Last Update Date | 02/10/2026
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Provider Practice Location Address
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Address Line | 4211 FAIRFAX CORNER AVE E STE 225
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City | FAIRFAX
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State | VA
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Zip | 22030-8623
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Country | US
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Telephone | 703-278-2473
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Fax | 703-239-4857
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Provider Business Mailing Address
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Address Line | 4211 FAIRFAX CORNER AVE E STE 225
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City | FAIRFAX
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State | VA
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Zip | 22030-8623
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Country | US
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Telephone | 703-278-2473
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Fax | 703-239-4857
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Authorized Official
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Title or Position | DERMATOLOGIST
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Name | DR. ETSUBDENK MEZEMIR AJEBO
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Credential | MD
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Telephone | 703-278-2473
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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