Provider Demographics
NPI:1215903356
Name:SHOUP, MARGARET C (MD)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:C
Last Name:SHOUP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 S ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2134
Mailing Address - Country:US
Mailing Address - Phone:321-843-6498
Mailing Address - Fax:321-843-2701
Practice Address - Street 1:1400 S ORANGE AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2134
Practice Address - Country:US
Practice Address - Phone:321-843-6498
Practice Address - Fax:321-843-2701
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT062227208600000X, 2086X0206X
FLME1512582086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL206147205OtherMEDICARE (INDIVIDUAL)
IL036093029Medicaid
IL203147OtherMEDICARE (GROUP)
IL203147OtherMEDICARE (GROUP)