Provider Demographics
NPI:1265629547
Name:LYONS, GLENN P (PA)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:P
Last Name:LYONS
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:96 COURT ST
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-2733
Mailing Address - Country:US
Mailing Address - Phone:518-562-2369
Mailing Address - Fax:518-562-2263
Practice Address - Street 1:96 COURT ST
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-2733
Practice Address - Country:US
Practice Address - Phone:518-562-2369
Practice Address - Fax:518-562-2263
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2023-12-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY009469208D00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice