1578620779 NPI number — CALVERTHEALTH MEDICAL CENTER, INC.

Table of content: (NPI 1578620779)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578620779 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:
1578620779
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:
410-286-7911
Provider Business Mailing Address Fax Number:
410-286-7913

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10845 TOWN CENTER BLVD
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
DUNKIRK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20754-2712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-286-7911
Provider Business Practice Location Address Fax Number:
410-286-7913
Provider Enumeration Date:
01/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TEAGUE
Authorized Official First Name:
DEAN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT & C.E.O.
Authorized Official Telephone Number:
410-535-8239

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 420456500 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com