Healthcare Provider Details

I. General information

NPI: 1992150692
Provider Name (Legal Business Name): CAITLIN TALLANT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAITLIN FOSTER

II. Dates (important events)

Enumeration Date: 05/01/2016
Last Update Date: 05/13/2020
Certification Date: 05/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USS ARLINGTON (LPD 24)
FPO AE
09564-1706
US

IV. Provider business mailing address

USS ARLINGTON (LPD 24)
FPO AE
09564-1706
US

V. Phone/Fax

Practice location:
  • Phone: 757-567-1182
  • Fax:
Mailing address:
  • Phone: 757-567-1182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0101263046
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number0101263046
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: