Provider Demographics
NPI:1255315396
Name:SHOUPE, BRADEN ALAN (MD)
Entity Type:Individual
Prefix:
First Name:BRADEN
Middle Name:ALAN
Last Name:SHOUPE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3700 FETTLER PARK DR
Mailing Address - Street 2:
Mailing Address - City:DUMFRIES
Mailing Address - State:VA
Mailing Address - Zip Code:22025-2050
Mailing Address - Country:DE
Mailing Address - Phone:703-441-7500
Mailing Address - Fax:
Practice Address - Street 1:LANDSTUHL REGIONAL MEDICAL CENTER
Practice Address - Street 2:BLDG 3767 (9A)
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09810
Practice Address - Country:DE
Practice Address - Phone:01149637-186-5300
Practice Address - Fax:01149637-186-8192
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-02
Last Update Date:2022-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC310722080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology