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  7. NPI Record 1700077237

DR. LISA MARIA JACOB M.D.
Complete NPI Record 1700077237
Plastic Surgery in Wilkes Barre, PA

NPI Status: Active since August 08, 2007

Contact Information

675 BALTIMORE DRIVE
WILKES BARRE, PA
ZIP 18702
Phone: (570) 808-6400
Fax: (570) 808-6338

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Provider Last Name Legal Name
  4. Provider First Name
  5. Provider Middle Name
  6. Provider Name Prefix Text
  7. Provider Credential Text
  8. Provider First Line Business Mailing Address
  9. Provider Business Mailing Address City Name
  10. Provider Business Mailing Address State Name
  11. Provider Business Mailing Address Postal Code
  12. Provider Business Mailing Address Country Code If outside U S
  13. Provider Business Mailing Address Telephone Number
  14. Provider Business Mailing Address Fax Number
  15. Provider First Line Business Practice Location Address
  16. Provider Business Practice Location Address City Name
  17. Provider Business Practice Location Address State Name
  18. Provider Business Practice Location Address Postal Code
  19. Provider Business Practice Location Address Country Code If outside U S
  20. Provider Business Practice Location Address Telephone Number
  21. Provider Business Practice Location Address Fax Number
  22. Provider Enumeration Date
  23. Last Update Date
  24. Provider Gender Code
  25. Healthcare Provider Taxonomy Code 1
  26. Provider License Number 1
  27. Provider License Number State Code 1
  28. Healthcare Provider Primary Taxonomy Switch 1
  29. Healthcare Provider Taxonomy Code 2
  30. Provider License Number 2
  31. Provider License Number State Code 2
  32. Healthcare Provider Primary Taxonomy Switch 2
  33. Healthcare Provider Taxonomy Code 3
  34. Provider License Number 3
  35. Provider License Number State Code 3
  36. Healthcare Provider Primary Taxonomy Switch 3
  37. Is Sole Proprietor
  38. NPI Certification Date

Complete NPI Dataset

This page represents the complete record for NPI 1700077237. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1700077237
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Entity Type Code: 1
The last name of the provider. If the provider is an individual, this is the legal name.
The last name of the provider. If the provider is an individual, this is the legal name.
Provider First Name: LISA
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Middle Name: MARIA
The country code in the location address of the provider being identified.
Provider Name Prefix Text: DR.
The telephone number associated with the location address of the provider being identified.
Provider Credential Text: M.D.
The fax number associated with the location address of the provider being identified.
Provider First Line Business Mailing Address: 100 N ACADEMY AVE
The date the provider was assigned a unique identifier (assigned an NPI).
Provider Business Mailing Address City Name: DANVILLE
The date that a record was last updated or changed.
Provider Business Mailing Address State Name: PA
The code designating the provider’s gender if the provider is a person.
Provider Business Mailing Address Postal Code: 178224903
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number: 5702716144
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Mailing Address Fax Number: 5702716578
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider First Line Business Practice Location Address: 675 BALTIMORE DRIVE
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: WILKES BARRE
Provider Business Practice Location Address State Name: PA
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider Business Practice Location Address Postal Code: 187023306
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Provider Business Practice Location Address Country Code If outside U S : US
Provider Business Practice Location Address Telephone Number: 5708086400
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No
Provider Business Practice Location Address Fax Number: 5708086338
The fax number associated with the location address of the provider being identified.
Provider Enumeration Date: 8/8/2007
The fax number associated with the location address of the provider being identified.
Last Update Date: 8/11/2020
The date that a record was last updated or changed.
Provider Gender Code: F
The date that a record was last updated or changed.
Healthcare Provider Taxonomy Code 1: 208200000X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider License Number 1: MD452576
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider License Number State Code 1: PA
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 1: Y
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Taxonomy Code 2: 208200000X
Provider License Number 2: 24109
Provider License Number State Code 2: WV
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 2: N
Healthcare Provider Taxonomy Code 3: 208200000X
Provider License Number 3: 25MA08245300
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 3: NJ
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 3: N
Is Sole Proprietor: N
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No
NPI Certification Date: 8/11/2020