Provider Demographics
NPI:1962874891
Name:CALDWELL, TIARA (IBCLC)
Entity type:Individual
Prefix:
First Name:TIARA
Middle Name:
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8909 CHESTER GROVE TER
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-2476
Mailing Address - Country:US
Mailing Address - Phone:301-404-0821
Mailing Address - Fax:
Practice Address - Street 1:8909 CHESTER GROVE TER
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-2476
Practice Address - Country:US
Practice Address - Phone:301-996-0649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-30
Last Update Date:2024-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDL-86062174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN