Provider Demographics
NPI:1548247414
Name:JARAMILLO, MARTA CECILIA (PA C)
Entity type:Individual
Prefix:
First Name:MARTA
Middle Name:CECILIA
Last Name:JARAMILLO
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:MARTA
Other - Middle Name:CECILIA
Other - Last Name:RANA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 820933
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-0933
Mailing Address - Country:US
Mailing Address - Phone:215-324-0600
Mailing Address - Fax:215-324-2795
Practice Address - Street 1:133 W HUNTING PARK AVE
Practice Address - Street 2:SUITE 300A
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-2717
Practice Address - Country:US
Practice Address - Phone:215-324-0600
Practice Address - Fax:215-324-2795
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA001698L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA073126Medicare PIN
PA115323JTQMedicare PIN
S62746Medicare UPIN