Provider Demographics
NPI:1417627027
Name:EXCELLENCE MEDICAL SERVICES
Entity Type:Organization
Organization Name:EXCELLENCE MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:N
Authorized Official - Last Name:ENOW
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:240-593-5983
Mailing Address - Street 1:7282 DORCHESTER WOODS LN
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076-2038
Mailing Address - Country:US
Mailing Address - Phone:240-593-5983
Mailing Address - Fax:
Practice Address - Street 1:7282 DORCHESTER WOODS LN
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MD
Practice Address - Zip Code:21076-2038
Practice Address - Country:US
Practice Address - Phone:240-593-5983
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty