MEDICARE: CALVARY HEALTH LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1558217141
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CALVARY HEALTH LLC

Provider Business Mailing Address
First Line	:	10346 SUGARBERRY ST
Second Line	:
City	:	WALDORF
State	:	MD
Zip	:	20603-5788
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10346 SUGARBERRY ST
Second Line	:
City	:	WALDORF
State	:	MD
Zip	:	20603-5788
Country	:	US
Telephone Number	:	240-478-2266
Fax Number	:

Authorized Official
Title or Position	:	CEO & OWNER
Name	:	KELWIN OKWUDIOGOR
Credential	:
Telephone Number	:	240-478-2266

Provider Enumeration Date	:	03/06/2026
Last Update Date	:	03/06/2026

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