Provider Demographics
NPI:1437137403
Name:LYONS, CLIFFORD HAYES (MD)
Entity Type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:HAYES
Last Name:LYONS
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 1:16 FORGE DAM RD
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:PA
Mailing Address - Zip Code:19526-7971
Mailing Address - Country:US
Mailing Address - Phone:610-488-0788
Mailing Address - Fax:
Practice Address - Street 1:16 FORGE DAM RD
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:PA
Practice Address - Zip Code:19526-7971
Practice Address - Country:US
Practice Address - Phone:610-488-0788
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD031996-E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1107585Medicaid
C29788Medicare UPIN
095825Medicare ID - Type Unspecified