Healthcare Provider Details

I. General information

NPI: 1811332430
Provider Name (Legal Business Name): CALVERT COUNTY HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2013
Last Update Date: 05/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 SOLOMONS ISLAND RD N
PRINCE FREDERICK MD
20678-3917
US

IV. Provider business mailing address

975 SOLOMONS ISLAND RD N PO BOX 980
PRINCE FREDERICK MD
20678-0980
US

V. Phone/Fax

Practice location:
  • Phone: 410-535-5400
  • Fax: 410-535-5285
Mailing address:
  • Phone: 410-535-5400
  • Fax: 410-535-5285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberD0050213
License Number StateMD

VIII. Authorized Official

Name: DR. LAURENCE BERNARD POLSKY
Title or Position: HEALTH OFFICER
Credential: M.D.
Phone: 410-535-5400