Provider Demographics
NPI:1780640433
Name:LYONS, KAREN MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:MARIE
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 1:219 N. BROAD STREET
Mailing Address - Street 2:10TH FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-1506
Mailing Address - Country:US
Mailing Address - Phone:215-762-5530
Mailing Address - Fax:215-762-5540
Practice Address - Street 1:219 N. BROAD STREET
Practice Address - Street 2:10TH FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-1506
Practice Address - Country:US
Practice Address - Phone:215-762-5530
Practice Address - Fax:215-762-5540
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD025473E207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001199380Medicaid
PA147436Medicare ID - Type Unspecified
PAC31823Medicare UPIN