Provider Demographics
NPI:1407602519
Name:BRAUCKMANN, ALYSSA LAUREL (DO)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:LAUREL
Last Name:BRAUCKMANN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8955 WOOD RD BLDG 1
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20889-5628
Mailing Address - Country:US
Mailing Address - Phone:301-319-8278
Mailing Address - Fax:
Practice Address - Street 1:8955 WOOD RD BLDG 1
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-5628
Practice Address - Country:US
Practice Address - Phone:301-319-8278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program