Healthcare Provider Details

I. General information

NPI: 1598794091
Provider Name (Legal Business Name): CALVERT MEMORIAL HOSPITAL OF CALVERT COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 04/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HOSPITAL RD
PRINCE FREDERICK MD
20678-4017
US

IV. Provider business mailing address

100 HOSPITAL RD
PRINCE FREDERICK MD
20678-4017
US

V. Phone/Fax

Practice location:
  • Phone: 410-535-8141
  • Fax: 410-535-8145
Mailing address:
  • Phone: 410-535-8141
  • Fax: 410-535-8145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number04-005
License Number StateMD

VIII. Authorized Official

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