MEDICARE: CALVERTHEALTH MEDICAL GROUP, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	363A00000X	Physician Assistant
2	363L00000X	Nurse Practitioner
3	363LF0000X	Family Nurse Practitioner
4	363LW0102X	Women's Health Nurse Practitioner
5	207V00000X	Obstetrics & Gynecology Physician

General Provider Information

NPI Number	:	1649017476
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CALVERTHEALTH MEDICAL GROUP, LLC

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 204
Second Line	:
City	:	PRINCE FREDERICK
State	:	MD
Zip	:	20678-4045
Country	:	US
Telephone Number	:	410-414-4740
Fax Number	:	410-414-4741

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, LLC ” Practice Location

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