Healthcare Provider Details

I. General information

NPI: 1942657051
Provider Name (Legal Business Name): CALVERTHEALTH MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2016
Last Update Date: 01/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14090 HG TRUEMAN RD SUITE 1500
SOLOMONS MD
20688-3151
US

IV. Provider business mailing address

100 HOSPITAL RD ATT: CONTRACT & CREDENTIALING
PRINCE FREDERICK MD
20678-4017
US

V. Phone/Fax

Practice location:
  • Phone: 410-394-2838
  • Fax: 410-326-5369
Mailing address:
  • Phone: 410-414-4791
  • Fax: 410-414-4558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DEAN TEAGUE
Title or Position: PRESIDENT/CEO
Credential:
Phone: 410-535-8239