Provider Demographics
NPI:1831488063
Name:CALVERT NEPHROLOGY GROUP, LLC
Entity Type:Organization
Organization Name:CALVERT NEPHROLOGY GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER/BILLING ADMIN.
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LINCOLN
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:410-261-8531
Mailing Address - Street 1:3333 N CALVERT ST
Mailing Address - Street 2:STE. 585
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-2867
Mailing Address - Country:US
Mailing Address - Phone:410-261-8532
Mailing Address - Fax:410-261-8055
Practice Address - Street 1:3333 N CALVERT ST
Practice Address - Street 2:STE. 585
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-2867
Practice Address - Country:US
Practice Address - Phone:410-261-8532
Practice Address - Fax:410-261-8055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-28
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0063540207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD019875700Medicaid
MD019875700Medicaid