1659550994 NPI number — CALVERTHEALTH MEDICAL CENTER, INC.

Table of content: (NPI 1659550994)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659550994 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:
1659550994
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/25/2018
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:
410-535-8259
Provider Business Mailing Address Fax Number:
410-535-8417

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
29449 CHARLOTTE HALL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLOTTE HALL
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20622-3042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-414-4539
Provider Business Practice Location Address Fax Number:
410-414-4540
Provider Enumeration Date:
11/02/2007

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: 261QR0208X , with the licence number:  04-001 , 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)





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