Provider Demographics
NPI:1043278385
Name:LYON-LOFTUS, GREGORY T (PHD MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:T
Last Name:LYON-LOFTUS
Suffix:
Gender:M
Credentials:PHD MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:785 5TH AVENUE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4232
Mailing Address - Country:US
Mailing Address - Phone:717-263-9555
Mailing Address - Fax:717-262-4217
Practice Address - Street 1:6155 ANTHONY HIGHWAY
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:PA
Practice Address - Zip Code:17268-9718
Practice Address - Country:US
Practice Address - Phone:717-749-3181
Practice Address - Fax:717-749-3191
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD030928E207Q00000X, 207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000970434 0003Medicaid
PA120420417OtherDEPT OF LABOR
PA25-1716306OtherSOUTH CENTRAL PREFERRED
PA25-1716306OtherMULTIPLAN/PHCS
PAP00468816OtherRAILROAD MEDICARE
PA25-1716306OtherDEVON
PA50074258OtherCAPITAL BLUECROSS
PA226900OtherUNISON
PA4601928OtherAETNA NON-HMO
PA098297OtherHIGHMARK BLUESHIELD
PA1007307260034OtherMEDICAID GROUP #
PA715056OtherHEALTH AMERICA
PA844639OtherAETNA HMO
PA25-1716306OtherHEALTHNET/TRICARE
PAMD030928EOtherLICENSE
PA25-1716306OtherINTERGROUP
PAP008956OtherGATEWAY
PA25-1716306OtherINFORMED
PA867633OtherMEDICARE GROUP #
PAG920-0083/KDM4CUOtherCAREFIRST
PAG920-0083/KDM4CUOtherCAREFIRST
PAG920-0083/KDM4CUOtherCAREFIRST
PA098297LN7Medicare PIN