Provider Demographics
NPI:1780333203
Name:CALDERON, BRYAN (HAD)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:CALDERON
Suffix:
Gender:M
Credentials:HAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11621 NEBEL ST
Mailing Address - Street 2:
Mailing Address - City:NORTH BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20852-2503
Mailing Address - Country:US
Mailing Address - Phone:240-669-9403
Mailing Address - Fax:
Practice Address - Street 1:11621 NEBEL ST
Practice Address - Street 2:
Practice Address - City:NORTH BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20852-2503
Practice Address - Country:US
Practice Address - Phone:240-669-9403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02891237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist