Provider Demographics
NPI:1932553559
Name:EXCEL ORTHOPAEDIC SPECIALISTS
Entity type:Organization
Organization Name:EXCEL ORTHOPAEDIC SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:IANNICIELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-782-1344
Mailing Address - Street 1:200 UNICORN PARK DR STE 201
Mailing Address - Street 2:
Mailing Address - City:WOBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01801-3342
Mailing Address - Country:US
Mailing Address - Phone:781-782-1300
Mailing Address - Fax:781-782-1350
Practice Address - Street 1:200 UNICORN PARK DR STE 201
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-3342
Practice Address - Country:US
Practice Address - Phone:781-782-1300
Practice Address - Fax:781-782-1350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-20
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAM13577Medicare UPIN
MA4788150001Medicare NSC