Provider Demographics
NPI:1427847540
Name:CALVERTHEALTH MEDICAL GROUP, LLC
Entity type:Organization
Organization Name:CALVERTHEALTH MEDICAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO/VP OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:HEITHAUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-535-8236
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:410-535-8248
Mailing Address - Fax:410-535-8417
Practice Address - Street 1:110 HOSPITAL RD STE 310
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-4041
Practice Address - Country:US
Practice Address - Phone:410-414-4740
Practice Address - Fax:410-414-4741
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CALVERT HEALTH SYSTEM, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Multi-Specialty