=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548235195
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARINA JARAMILLO MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/17/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14 LAKE CHEROKEE DR
-----------------------------------------------------
City | RANDOLPH
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07869-2800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-895-2532
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14 LAKE CHEROKEE DR
-----------------------------------------------------
City | RANDOLPH
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07869-2800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-895-2532
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207ZP0102X
-----------------------------------------------------
Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
-----------------------------------------------------
License Number | 27222
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------