Healthcare Provider Details

I. General information

NPI: 1427847540
Provider Name (Legal Business Name): CALVERTHEALTH MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2025
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 HOSPITAL RD STE 310
PRINCE FREDERICK MD
20678-4041
US

IV. Provider business mailing address

100 HOSPITAL RD
PRINCE FREDERICK MD
20678-4017
US

V. Phone/Fax

Practice location:
  • Phone: 410-414-4740
  • Fax: 410-414-4741
Mailing address:
  • Phone: 410-535-8248
  • Fax: 410-535-8417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: CAROLYN HEITHAUS
Title or Position: CFO/VP OF FINANCE
Credential:
Phone: 410-535-8236