Healthcare Provider Details

I. General information

NPI: 1255422655
Provider Name (Legal Business Name): ALLEGANY INTERNAL MEDICINE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 07/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 MEMORIAL AVE SUITE 301
CUMBERLAND MD
21502-3765
US

IV. Provider business mailing address

600 MEMORIAL AVE SUITE 301
CUMBERLAND MD
21502-3765
US

V. Phone/Fax

Practice location:
  • Phone: 301-759-4544
  • Fax: 301-723-4446
Mailing address:
  • Phone: 301-759-4544
  • Fax: 301-723-4446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0054411
License Number StateMD

VIII. Authorized Official

Name: DR. BEVERLY M CALKINS
Title or Position: OWNER/PRESIDENT
Credential: MD
Phone: 301-759-4544