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General NPI Number Information
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NPI Number | 1174682298
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Entity Type | Organization
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Legal Business Name | CALVERT INTERNAL MEDICINE GROUP PA
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 985 PRINCE FREDERICK BLVD STE 201
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City | PRINCE FREDERICK
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State | MD
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Zip | 20678-3492
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Country | US
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Telephone | 410-535-2005
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Fax | 410-535-4761
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Provider Business Mailing Address
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Address Line | 985 PRINCE FREDERICK BLVD SUITE 201
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City | PRINCE FREDERICK
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State | MD
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Zip | 20678-3492
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Country | US
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Telephone | 410-535-2005
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Fax | 410-535-4850
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Authorized Official
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Title or Position | PRESIDENT
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Name | JONATHAN LOWENTHAL
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Credential | MD
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Telephone | 410-535-2005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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