Provider Demographics
NPI:1710513320
Name:EXQUISITE MED LLC
Entity Type:Organization
Organization Name:EXQUISITE MED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OBINNA
Authorized Official - Middle Name:
Authorized Official - Last Name:HERBERTS NWAEHIHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:833-233-6800
Mailing Address - Street 1:411 WARFIELD DR APT 4019
Mailing Address - Street 2:
Mailing Address - City:LANDOVER
Mailing Address - State:MD
Mailing Address - Zip Code:20785-5531
Mailing Address - Country:US
Mailing Address - Phone:833-233-6800
Mailing Address - Fax:877-310-8005
Practice Address - Street 1:8201 CORPORATE DR STE 630
Practice Address - Street 2:
Practice Address - City:LANDOVER
Practice Address - State:MD
Practice Address - Zip Code:20785-2371
Practice Address - Country:US
Practice Address - Phone:833-233-6800
Practice Address - Fax:877-310-8005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-14
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty