Provider Demographics
NPI:1487891255
Name:OMBAO, JOLLY LOZANO (MD)
Entity type:Individual
Prefix:DR
First Name:JOLLY
Middle Name:LOZANO
Last Name:OMBAO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:25 CHURCH ST
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-3507
Practice Address - Country:US
Practice Address - Phone:570-808-3100
Practice Address - Fax:570-808-8739
Is Sole Proprietor?:No
Enumeration Date:2009-01-14
Last Update Date:2025-03-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY60251679207LP2900X
PAMD440826207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine