Healthcare Provider Details

I. General information

NPI: 1922332659
Provider Name (Legal Business Name): CALVERT MEMORIAL HOSPITAL OF CALVERT COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2009
Last Update Date: 09/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2553 N SOLOMONS ISLAND RD
HUNTINGTOWN MD
20639
US

IV. Provider business mailing address

100 HOSPITAL RD
PRINCE FREDERICK MD
20678-4017
US

V. Phone/Fax

Practice location:
  • Phone: 410-535-8402
  • Fax: 410-535-8397
Mailing address:
  • Phone: 410-535-8402
  • Fax: 410-535-8397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number04-001
License Number StateMD

VIII. Authorized Official

Name: MR. JAMES J XINIS
Title or Position: PRESIDENT/CEO
Credential:
Phone: 410-535-8239