# CALVERT OBGYN ASSOCIATES OF SOUTHERN MARYLAND, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104940139
- **Authorized official:** DR. JOSEPH R TIRALLA MD (MANAGING MEMBER)
- **Authorized official phone:** (410) 535-3642

## Contact information

- **Practice address:** 110 HOSPITAL RD, SUITE 211, PRINCE FREDERICK, MD 20678-4019
- **Practice address phone:** (410) 535-3642
- **Practice address fax:** (410) 535-6836
- **Mailing address:** 110 HOSPITAL RD, SUITE 211, PRINCE FREDERICK, MD 20678-4019
- **Mailing address phone:** (410) 535-3642
- **Mailing address fax:** (410) 535-6836

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | Yes |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/16/2007
- **Last updated:** 08/22/2020