Healthcare Provider Details

I. General information

NPI: 1669632071
Provider Name (Legal Business Name): CALVERT EAR NOSE & THROAT ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2008
Last Update Date: 11/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 HOSPITAL RD SUITE # 204
PRINCE FREDERICK MD
20678-4019
US

IV. Provider business mailing address

110 HOSPITAL RD SUITE # 204
PRINCE FREDERICK MD
20678-4019
US

V. Phone/Fax

Practice location:
  • Phone: 410-535-9555
  • Fax:
Mailing address:
  • Phone: 410-535-9555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberD47767
License Number StateMD

VIII. Authorized Official

Name: DR. BETH R DUNCAN
Title or Position: PRESIDENT
Credential: MD
Phone: 410-535-9555