Provider Demographics
NPI:1710782131
Name:EXCELLE MEDICAL CLINIC INC
Entity type:Organization
Organization Name:EXCELLE MEDICAL CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAIWO
Authorized Official - Middle Name:RITA
Authorized Official - Last Name:ASAOLU
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:443-630-2185
Mailing Address - Street 1:7515 GILLEY TER
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-3703
Mailing Address - Country:US
Mailing Address - Phone:443-630-2185
Mailing Address - Fax:
Practice Address - Street 1:7515 GILLEY TER
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:MD
Practice Address - Zip Code:21237-3703
Practice Address - Country:US
Practice Address - Phone:443-630-2185
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care