Provider Demographics
NPI:1184866980
Name:BRADEN, JACQUELINE MILLER (DO)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:MILLER
Last Name:BRADEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:JACQUELINE
Other - Middle Name:MARIE
Other - Last Name:BRADEN-ELINICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:8930 BROWN DR BLDG 92ND
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20889-5629
Mailing Address - Country:US
Mailing Address - Phone:301-295-8893
Mailing Address - Fax:
Practice Address - Street 1:8930 BROWN DR BLDG 92ND
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-5629
Practice Address - Country:US
Practice Address - Phone:301-400-2686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-25
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDOS-1328207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN