Provider Demographics
NPI:1477544583
Name:LYONS, JOHN CORNELIUS (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:CORNELIUS
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 1:2152 S SHORE DR
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-2248
Mailing Address - Country:US
Mailing Address - Phone:814-455-2170
Mailing Address - Fax:814-455-9119
Practice Address - Street 1:2566 W 12TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-4508
Practice Address - Country:US
Practice Address - Phone:814-455-2170
Practice Address - Fax:814-455-9119
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD025800E207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE55497Medicare UPIN
PA158218LEZMedicare ID - Type Unspecified