Provider Demographics
NPI:1902841463
Name:LYON, CAROLINE ELISE (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:ELISE
Last Name:LYON
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:ELISE
Other - Last Name:BULLOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:23 SOUTHVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-6518
Mailing Address - Country:US
Mailing Address - Phone:802-860-7252
Mailing Address - Fax:
Practice Address - Street 1:111 COLCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-1473
Practice Address - Country:US
Practice Address - Phone:802-847-4237
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420011075207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine