Provider Demographics
NPI:1407846702
Name:LYONS, CAROL ANN (MD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:LYONS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:717 STATE ST
Mailing Address - Street 2:SUITE 16 LL
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16501
Mailing Address - Country:US
Mailing Address - Phone:814-480-7100
Mailing Address - Fax:814-480-7604
Practice Address - Street 1:104 EAST 2ND ST
Practice Address - Street 2:5TH FLOOR
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507
Practice Address - Country:US
Practice Address - Phone:814-838-0990
Practice Address - Fax:814-838-0994
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD027535E2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC31074Medicare UPIN
PA128991Medicare ID - Type Unspecified