Healthcare Provider Details

I. General information

NPI: 1356254304
Provider Name (Legal Business Name): EXCELSIOR MEDICINE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12359 SUNRISE VALLEY DR STE 260
RESTON VA
20191-3494
US

IV. Provider business mailing address

12359 SUNRISE VALLEY DR STE 260
RESTON VA
20191-3494
US

V. Phone/Fax

Practice location:
  • Phone: 571-267-7204
  • Fax:
Mailing address:
  • Phone: 571-267-7204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: RAJU ALLURI
Title or Position: OWNER
Credential: MD
Phone: 703-376-4777