Provider Demographics
NPI:1720384225
Name:ALBERT W LYON MD PA
Entity Type:Organization
Organization Name:ALBERT W LYON MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:WILFRED
Authorized Official - Last Name:LYON
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:409-853-3026
Mailing Address - Street 1:1323 S 27TH ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:NEDERLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77627-6257
Mailing Address - Country:US
Mailing Address - Phone:409-883-0050
Mailing Address - Fax:409-444-2983
Practice Address - Street 1:1323 S 27TH ST
Practice Address - Street 2:SUITE 400
Practice Address - City:NEDERLAND
Practice Address - State:TX
Practice Address - Zip Code:77627-6257
Practice Address - Country:US
Practice Address - Phone:409-883-0050
Practice Address - Fax:409-444-2983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-31
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02926401Medicaid
NYRB6069Medicare UPIN
NY02926401Medicaid