MEDICARE: BRYAN CALDERON HAD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	237700000X	Hearing Instrument Specialist	02891	MD

General Provider Information

NPI Number	:	1780333203
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRYAN CALDERON HAD

Provider Business Mailing Address
First Line	:	11621 NEBEL ST
Second Line	:
City	:	NORTH BETHESDA
State	:	MD
Zip	:	20852-2503
Country	:	US
Telephone Number	:	240-669-9403
Fax Number	:

Provider Business Practice Location Address
First Line	:	11621 NEBEL ST
Second Line	:
City	:	NORTH BETHESDA
State	:	MD
Zip	:	20852-2503
Country	:	US
Telephone Number	:	240-669-9403
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2022
Last Update Date	:	03/22/2022

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