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General NPI Number Information
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NPI Number | 1528880523
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Entity Type | Organization
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Legal Business Name | CALVERTHEALTH MEDICAL GROUP, LLC
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Dates
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Enumeration Date | 10/30/2024
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Last Update Date | 10/30/2024
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Provider Practice Location Address
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Address Line | 130 HOSPITAL RD STE 102
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City | PRINCE FREDERICK
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State | MD
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Zip | 20678-4029
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Country | US
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Telephone | 410-846-8800
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Fax | 410-469-1724
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Provider Business Mailing Address
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Address Line | 100 HOSPITAL RD
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City | PRINCE FREDERICK
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State | MD
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Zip | 20678-4017
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Country | US
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Telephone | 410-414-4791
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Fax | 410-535-8417
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Authorized Official
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Title or Position | CFO/VP FINANCE
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Name | CAROLYN HEITHAUS
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Credential |
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Telephone | 410-535-8236
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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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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Taxonomy #4
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 2086S0105X
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Taxonomy Name | Surgery of the Hand (Surgery) Physician
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #11
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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