1588808935 NPI number — CALVERTHEALTH MEDICAL CENTER, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588808935 NPI number — CALVERTHEALTH MEDICAL CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CALVERTHEALTH MEDICAL CENTER, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588808935
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/24/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 HOSPITAL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRINCE FREDERICK
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20678-4017
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-394-2830
Provider Business Mailing Address Fax Number:
410-394-2835

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14090 HG TRUEMAN RD
Provider Second Line Business Practice Location Address:
STE 1400
Provider Business Practice Location Address City Name:
SOLOMONS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20688-3151
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-394-2830
Provider Business Practice Location Address Fax Number:
410-394-2835
Provider Enumeration Date:
04/29/2009

Additional Information

Authorized Official

Authorized Official Last Name:
TEAGUE
Authorized Official First Name:
DEAN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
410-535-8239

Provider Taxonomy Codes

  • Taxonomy code: 261QR0200X , with the licence number:  261QR0200X , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 621307300 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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