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General NPI Number Information
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NPI Number | 1710782131
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Entity Type | Organization
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Legal Business Name | EXCELLE MEDICAL CLINIC INC
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Dates
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Enumeration Date | 02/18/2025
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Last Update Date | 01/23/2026
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Provider Practice Location Address
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Address Line | 1134 YORK RD STE 208
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City | LUTHERVILLE
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State | MD
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Zip | 21093-6204
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Country | US
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Telephone | 667-206-2520
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Fax | 949-693-4581
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Provider Business Mailing Address
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Address Line | 7515 GILLEY TER
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City | ROSEDALE
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State | MD
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Zip | 21237-3703
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Country | US
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Telephone | 443-630-2185
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. TAIWO RITA ASAOLU
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Credential | NURSE PRACTITIONER
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Telephone | 443-630-2185
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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