Provider Demographics
NPI:1477547479
Name:LYND, JR., CLIFFORD W (MD)
Entity Type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:W
Last Name:LYND, JR.
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 1:1803 MOUNT ROSE AVE
Mailing Address - Street 2:SUITE B3
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-3026
Mailing Address - Country:US
Mailing Address - Phone:717-851-1405
Mailing Address - Fax:717-851-1665
Practice Address - Street 1:25 MONUMENT RD
Practice Address - Street 2:SUITE 190
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-5060
Practice Address - Country:US
Practice Address - Phone:717-851-6454
Practice Address - Fax:717-851-1665
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
PAMD013609E2086S0129X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No174400000XOther Service ProvidersSpecialist
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA249457OtherUNISON-WMG
MD037208100Medicaid
MD548801OtherCAREFIRST MD BCBS
PA1569365OtherGATEWAY-WMG
PA033231OtherJOHNS HOPKINS
PA34317OtherGEISINGER HEALTH PLAN
PA4269079OtherAETNA
PA50080379OtherCAPITAL BLUE CROSS-WMG
PA000633873Medicaid
PA20078590OtherAMERIHEALTH MERCY-WMG
MD037208100Medicaid
PAP00719133Medicare PIN
PA083209Medicare PIN