Provider Demographics
NPI:1174682298
Name:CALVERT INTERNAL MEDICINE GROUP PA
Entity Type:Organization
Organization Name:CALVERT INTERNAL MEDICINE GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOWENTHAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-535-2005
Mailing Address - Street 1:985 PRINCE FREDERICK BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-3492
Mailing Address - Country:US
Mailing Address - Phone:410-535-2005
Mailing Address - Fax:410-535-4850
Practice Address - Street 1:985 PRINCE FREDERICK BLVD STE 201
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-3492
Practice Address - Country:US
Practice Address - Phone:410-535-2005
Practice Address - Fax:410-535-4761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCC041OtherCAREFIRST OF DC
MDKB03OtherCAREFIRST OF MD
MD256411400Medicaid
DCC041OtherCAREFIRST OF DC
MD022LMedicare ID - Type UnspecifiedGROUP PROVIDER NUMBER