MEDICARE: DR. LISA MARIE JARAMILLO D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	OS017589	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	OS017589	OTHER	PA	LICENSE

General Provider Information

NPI Number	:	1487951406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA MARIE JARAMILLO D.O.

Provider Business Mailing Address
First Line	:	100 HOSPITAL AVE
Second Line	:
City	:	DU BOIS
State	:	PA
Zip	:	15801-1440
Country	:	US
Telephone Number	:	814-375-4024
Fax Number	:	814-372-2579

Provider Business Practice Location Address
First Line	:	100 N ACADEMY AVE
Second Line	:
City	:	DANVILLE
State	:	PA
Zip	:	17822
Country	:	US
Telephone Number	:	570-271-6298
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2011
Last Update Date	:	01/14/2026

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