Provider Demographics
NPI:1538113659
Name:SIDDOWAY, LYLE AMOS (MD)
Entity Type:Individual
Prefix:DR
First Name:LYLE
Middle Name:AMOS
Last Name:SIDDOWAY
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 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-851-2441
Mailing Address - Fax:
Practice Address - Street 1:30 MONUMENT RD
Practice Address - Street 2:SUITE 1100
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-5024
Practice Address - Country:US
Practice Address - Phone:717-851-2441
Practice Address - Fax:717-851-3521
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD044979E207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA20006623OtherAMERIHEALTH MERCY
PA577456OtherHIGHMARK BLUE SHIELD
PA1521565OtherGATEWAY
PA7243OtherGEISINGER
PA01939210OtherCAPITAL BLUE CROSS
PA001190133Medicaid
PA354482OtherCAREFIRST MD BLUE SHIELD
PA060013261OtherRAILROAD MEDICARE
PA086694OtherUNISON
PA001190133Medicaid
PA577456OtherHIGHMARK BLUE SHIELD
PAP01425255Medicare PIN
PA577456FLTMedicare PIN