Provider Demographics
NPI:1588808935
Name:CALVERTHEALTH MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:CALVERTHEALTH MEDICAL CENTER, INC.
Other - Org Name:CALVERTHEALTH SOLOMONS IMAGING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TEAGUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-535-8239
Mailing Address - Street 1:100 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-4017
Mailing Address - Country:US
Mailing Address - Phone:410-394-2830
Mailing Address - Fax:410-394-2835
Practice Address - Street 1:14090 HG TRUEMAN RD
Practice Address - Street 2:STE 1400
Practice Address - City:SOLOMONS
Practice Address - State:MD
Practice Address - Zip Code:20688-3151
Practice Address - Country:US
Practice Address - Phone:410-394-2830
Practice Address - Fax:410-394-2835
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CALVERT HEALTH SYSTEMS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-29
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD261QR0200X261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD621307300Medicaid
MD621307300Medicaid