Healthcare Provider Details

I. General information

NPI: 1659550994
Provider Name (Legal Business Name): CALVERTHEALTH MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2007
Last Update Date: 01/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29449 CHARLOTTE HALL RD
CHARLOTTE HALL MD
20622-3042
US

IV. Provider business mailing address

100 HOSPITAL RD
PRINCE FREDERICK MD
20678-4017
US

V. Phone/Fax

Practice location:
  • Phone: 410-414-4539
  • Fax: 410-414-4540
Mailing address:
  • Phone: 410-535-8259
  • Fax: 410-535-8417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number04-001
License Number StateMD

VIII. Authorized Official

Name: DEAN TEAGUE
Title or Position: PRESIDENT & C.E.O.
Credential:
Phone: 410-535-8239