# EXCELLENCE DIABETES ENDOCRINOLOGY & METABOLISM CENTER LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1295969913
- **Authorized official:** WILFRED M VICTORINA MD (OWNER)
- **Authorized official phone:** (859) 496-1803

## Contact information

- **Practice address:** 1000 N FRONT ST, SUITE 400, WORMLEYSBURG, PA 17043-1034
- **Practice address phone:** (717) 695-6741
- **Practice address fax:** (717) 695-6768
- **Mailing address:** 1000 N FRONT ST, SUITE 400, WORMLEYSBURG, PA 17043-1034
- **Mailing address phone:** (717) 695-6741
- **Mailing address fax:** (717) 695-6768

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | MD432714 | PA | Yes |

## Other

- **Enumeration date:** 05/09/2009
- **Last updated:** 06/26/2015