Provider Demographics
NPI:1790916815
Name:LYON, CAMERON D (PA-C)
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:D
Last Name:LYON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:197 RIDGEDALE AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:CEDAR KNOLLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07927-2111
Mailing Address - Country:US
Mailing Address - Phone:973-538-2334
Mailing Address - Fax:973-267-6882
Practice Address - Street 1:197 RIDGEDALE AVE FL 3
Practice Address - Street 2:
Practice Address - City:CEDAR KNOLLS
Practice Address - State:NJ
Practice Address - Zip Code:07927-2111
Practice Address - Country:US
Practice Address - Phone:973-538-2334
Practice Address - Fax:973-267-6882
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-01888363AM0700X
VA0110004096363AS0400X
NJ25MP00347700363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical