MEDICARE: CALVERTHEALTH MEDICAL GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207R00000X	Internal Medicine Physician
2	2086S0122X	Plastic and Reconstructive Surgery Physician
3	2086S0129X	Vascular Surgery Physician
4	208800000X	Urology Physician
5	363L00000X	Nurse Practitioner
6	363LA2200X	Adult Health Nurse Practitioner
7	363LF0000X	Family Nurse Practitioner
8	208600000X	Surgery Physician

General Provider Information

NPI Number	:	1629815451
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CALVERTHEALTH MEDICAL GROUP

Provider Business Mailing Address
First Line	:	100 HOSPITAL RD
Second Line	:
City	:	PRINCE FREDERICK
State	:	MD
Zip	:	20678-4017
Country	:	US
Telephone Number	:	410-414-4791
Fax Number	:	410-535-8417

Provider Business Practice Location Address
First Line	:	110 HOSPITAL RD STE 213
Second Line	:
City	:	PRINCE FREDERICK
State	:	MD
Zip	:	20678-4040
Country	:	US
Telephone Number	:	410-414-2790
Fax Number	:	410-414-2791

Authorized Official
Title or Position	:	CFO
Name	:	CAROLYN HEITHAUS
Credential	:
Telephone Number	:	410-535-8236

Provider Enumeration Date	:	07/10/2024
Last Update Date	:	07/10/2024

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Directions to “CALVERTHEALTH MEDICAL GROUP ” Practice Location

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