Provider Demographics
NPI:1225075260
Name:GAINES, LYNDON B (MD)
Entity Type:Individual
Prefix:
First Name:LYNDON
Middle Name:B
Last Name:GAINES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1560
Mailing Address - Country:US
Mailing Address - Phone:740-446-5381
Mailing Address - Fax:740-446-5082
Practice Address - Street 1:100 JACKSON PIKE
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-1560
Practice Address - Country:US
Practice Address - Phone:740-446-5381
Practice Address - Fax:740-446-5082
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV20258207V00000X
OH35-07-3976207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH310917085039OtherCARESOURCE MEDICAID
WV0093789000Medicaid
OH2052317Medicaid
000000006850OtherANTHEM BCBS
OH000000181641OtherUNISON MEDICAID
001714102OtherMOUNTAIN STATE BCBS
160037957OtherRR MEDICARE
OH2052317OtherMOLINA MEDICAID
OH310917085039OtherCARESOURCE MEDICAID
000000006850OtherANTHEM BCBS
WV0846832Medicare PIN