Provider Demographics
NPI:1548394026
Name:LYONS, WARREN MARLOWE (MD)
Entity Type:Individual
Prefix:DR
First Name:WARREN
Middle Name:MARLOWE
Last Name:LYONS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:WARREN
Other - Middle Name:MARLOWE
Other - Last Name:LYONS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:437 MARYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-5126
Mailing Address - Country:US
Mailing Address - Phone:718-448-6381
Mailing Address - Fax:
Practice Address - Street 1:8518 4TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-4608
Practice Address - Country:US
Practice Address - Phone:718-748-5482
Practice Address - Fax:718-748-3758
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY152639208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY77D371Medicare ID - Type Unspecified