Provider Demographics
NPI:1245441534
Name:LYONS, MARK D (PA-C)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:D
Last Name:LYONS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:452 W. ALLEGHENY AVE.
Mailing Address - Street 2:
Mailing Address - City:PHILA.
Mailing Address - State:PA
Mailing Address - Zip Code:19133
Mailing Address - Country:US
Mailing Address - Phone:215-291-2500
Mailing Address - Fax:215-291-2587
Practice Address - Street 1:452 W. ALLEGHENY AVE.
Practice Address - Street 2:
Practice Address - City:PHILA.
Practice Address - State:PA
Practice Address - Zip Code:19133
Practice Address - Country:US
Practice Address - Phone:215-291-2500
Practice Address - Fax:215-291-2587
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA000152L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant