Provider Demographics
NPI:1558409953
Name:LYONS, PAULA R (MD)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:R
Last Name:LYONS
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:PO BOX 759047
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21275-9047
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11722 REISTERSTOWN RD
Practice Address - Street 2:
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136-3302
Practice Address - Country:US
Practice Address - Phone:410-833-5000
Practice Address - Fax:410-833-1433
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD46733207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG09042Medicare UPIN
MD169968YVZMedicare PIN
MD169968ZDDBMedicare PIN
MD355797YWV2Medicare PIN