Provider Demographics
NPI:1609866342
Name:LYONS, CHRISTINA J (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:J
Last Name:LYONS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:CHRISTINA
Other - Middle Name:J
Other - Last Name:DODGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5096
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98227-5096
Mailing Address - Country:US
Mailing Address - Phone:360-738-2200
Mailing Address - Fax:360-752-5653
Practice Address - Street 1:4465 CORDATA PKWY
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-8037
Practice Address - Country:US
Practice Address - Phone:360-738-2200
Practice Address - Fax:360-752-5653
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60137774207N00000X
IN01058731A207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0265378OtherL&I AND CRIME VICTIMS
WA0031LYOtherREGENCE
WA1609866342Medicaid
WAG8893177Medicare PIN