Healthcare Provider Details

I. General information

NPI: 1306809710
Provider Name (Legal Business Name): RICHARD JOHN CALVERT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8901 WISCONSIN AVE
BETHESDA MD
20889-0001
US

IV. Provider business mailing address

12236 GALESVILLE DR
GAITHERSBURG MD
20878-2072
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-0196
  • Fax:
Mailing address:
  • Phone: 301-846-1246
  • Fax: 310-846-5946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101037536
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: