Organization
CALVERT OBGYN ASSOCIATES OF SOUTHERN MARYLAND, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSEPH R TIRALLA MD (MANAGING MEMBER)
(410) 535-3642
Entity
Organization
Contact information
Practice address
110 HOSPITAL RD, SUITE 211, PRINCE FREDERICK, MD 20678-4019
(410) 535-3642
(410) 535-6836
Mailing address
110 HOSPITAL RD, SUITE 211, PRINCE FREDERICK, MD 20678-4019
(410) 535-3642
(410) 535-6836
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2217716
AETNA US HEALTHCARE HMO
—
01
—
366483
MAMSI - SUITE 202
—
01
—
367313
MAMSI - SUITE #211
—
01
—
6906-0000
BLUE SHIELD DC
—
01
—
7394046
AETNA US HEALTHCARE PPO
—
01
—
KAN9CA
BLUE SHIELD OF MARYLAND
—
Enumeration date
03/16/2007
Last updated
08/22/2020
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