Provider Demographics
NPI:1861490989
Name:LYONS, THOMAS H (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:H
Last Name:LYONS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5 MILES CENTER WAY
Mailing Address - Street 2:UNIT 2
Mailing Address - City:DAMARISCOTTA
Mailing Address - State:ME
Mailing Address - Zip Code:04543-4067
Mailing Address - Country:US
Mailing Address - Phone:207-563-4252
Mailing Address - Fax:207-563-4246
Practice Address - Street 1:5 MILES CENTER WAY
Practice Address - Street 2:UNIT 2
Practice Address - City:DAMARISCOTTA
Practice Address - State:ME
Practice Address - Zip Code:04543-4067
Practice Address - Country:US
Practice Address - Phone:207-563-4252
Practice Address - Fax:207-563-4246
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ME014281208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE235480099Medicaid
NE235480099Medicaid
HX3700Medicare PIN