Provider Demographics
NPI:1477511640
Name:LYON-LOFTUS, DIANA J (MD)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:J
Last Name:LYON-LOFTUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:785 5TH AVENUE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4232
Mailing Address - Country:US
Mailing Address - Phone:717-263-9555
Mailing Address - Fax:717-217-4217
Practice Address - Street 1:12 ST PAUL DR STE 101
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-1035
Practice Address - Country:US
Practice Address - Phone:717-217-6760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD030841E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA25-1716306OtherINTERGROUP
PA25-1716306OtherMULTIPLAN/PHCS
PA25-1716306OtherSOUTH CENTRAL PREFERRED
PA098361OtherHIGHMARK BLUESHIELD
PA1007307260034OtherMEDICAID GROUP #
PA50074257OtherCAPITAL BLUECROSS
PAP009384OtherGATEWAY
PA120420417OtherDEPT OF LABOR
PA867633OtherMEDICARE GROUP #
PA226929OtherUNISON
PA4294849OtherAETNA NON-HMO
PA000970837 0001Medicaid
PA25-1716306OtherHEALTHNET/TRICARE
PA718122OtherHEALTH AMERICA
PA25-1716306OtherINFORMED
PA25-1716306OtherDEVON
PA841638OtherAETNA HMO
PAG920-0110/KDM4CUOtherCAREFIRST
PAMD030841EOtherLICENSE
PAP00390475OtherRAILROAD MEDICARE
PAP00390475OtherRAILROAD MEDICARE
PA718122OtherHEALTH AMERICA
PAG920-0110/KDM4CUOtherCAREFIRST