Provider Demographics
NPI:1225017049
Name:LYONS, MARK (DO)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:LYONS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:532 MAIN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MOOSIC
Mailing Address - State:PA
Mailing Address - Zip Code:18507-1001
Mailing Address - Country:US
Mailing Address - Phone:570-471-3569
Mailing Address - Fax:570-471-7052
Practice Address - Street 1:532 MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:MOOSIC
Practice Address - State:PA
Practice Address - Zip Code:18507-1001
Practice Address - Country:US
Practice Address - Phone:570-471-3569
Practice Address - Fax:570-471-7052
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0S009690L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001798330Medicaid
PA0037047DOLMedicare PIN
PA001798330Medicaid
PA037047Medicare PIN