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General NPI Number Information
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NPI Number | 1659550994
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Entity Type | Organization
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Legal Business Name | CALVERTHEALTH MEDICAL CENTER, INC.
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Dates
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Enumeration Date | 11/02/2007
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Last Update Date | 01/25/2018
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Provider Practice Location Address
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Address Line | 29449 CHARLOTTE HALL RD
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City | CHARLOTTE HALL
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State | MD
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Zip | 20622-3042
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Country | US
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Telephone | 410-414-4539
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Fax | 410-414-4540
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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 | 410-535-8259
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Fax | 410-535-8417
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Authorized Official
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Title or Position | PRESIDENT & C.E.O.
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Name | DEAN TEAGUE
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Credential |
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Telephone | 410-535-8239
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0208X
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Taxonomy Name | Mobile Radiology Clinic/Center
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License Number | 04-001
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License Number State | MD
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