Provider Demographics
NPI:1225781305
Name:EXCELSIOR HEALTHCARE ENTERPRISES
Entity Type:Organization
Organization Name:EXCELSIOR HEALTHCARE ENTERPRISES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:WIDS
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMEUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-486-1100
Mailing Address - Street 1:13103 OLD CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-4625
Mailing Address - Country:US
Mailing Address - Phone:240-486-1100
Mailing Address - Fax:301-860-0765
Practice Address - Street 1:12520 FAIRWOOD PKWY
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20720-6343
Practice Address - Country:US
Practice Address - Phone:240-486-1100
Practice Address - Fax:301-860-0765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-30
Last Update Date:2022-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty