Provider Demographics
NPI:1609068980
Name:CALVERT HOSPICE PHYSICIAN
Entity Type:Organization
Organization Name:CALVERT HOSPICE PHYSICIAN
Other - Org Name:CAVLERT HOSPICE PHYSICIAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHEIF EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FLEMING
Authorized Official - Suffix:
Authorized Official - Credentials:EDD, RN
Authorized Official - Phone:410-535-0892
Mailing Address - Street 1:PO BOX 838
Mailing Address - Street 2:
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-0838
Mailing Address - Country:US
Mailing Address - Phone:410-535-0892
Mailing Address - Fax:410-535-5677
Practice Address - Street 1:238 MERRIMAC CT
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678
Practice Address - Country:US
Practice Address - Phone:410-535-0892
Practice Address - Fax:410-535-5677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-10
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH1521251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD432431500Medicaid