Healthcare Provider Details

I. General information

NPI: 1306702139
Provider Name (Legal Business Name): EXCELSIS MEDICAL SUPPLY CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/24/2025
Last Update Date: 12/24/2025
Certification Date: 12/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 IRONGATE DR STE F
WALDORF MD
20602-2786
US

IV. Provider business mailing address

9310 CALIPH ST
BRANDYWINE MD
20613-7723
US

V. Phone/Fax

Practice location:
  • Phone: 301-266-7264
  • Fax: 844-554-4375
Mailing address:
  • Phone: 301-266-7264
  • Fax: 844-554-4375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: JAMES L TARVER
Title or Position: OWNER
Credential:
Phone: 301-266-7264