Provider Demographics
NPI:1922332659
Name:CALVERT MEMORIAL HOSPITAL OF CALVERT COUNTY
Entity Type:Organization
Organization Name:CALVERT MEMORIAL HOSPITAL OF CALVERT COUNTY
Other - Org Name:CALVERT COMMUNITY DENTAL CARE - HUNTINGTOWN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:XINIS
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:410-535-8402
Mailing Address - Fax:410-535-8397
Practice Address - Street 1:2553 N SOLOMONS ISLAND RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTOWN
Practice Address - State:MD
Practice Address - Zip Code:20639
Practice Address - Country:US
Practice Address - Phone:410-535-8402
Practice Address - Fax:410-535-8397
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CALVERT HEALTH SYSTEM, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-09-29
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04-0011223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty