Provider Demographics
NPI:1255434551
Name:LYONS, GERALD J JR (MD)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:J
Last Name:LYONS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 SWIFTWATER ROAD
Mailing Address - Street 2:COTTAGE HOSPITAL
Mailing Address - City:WOODSVILLE
Mailing Address - State:NH
Mailing Address - Zip Code:03785-2001
Mailing Address - Country:US
Mailing Address - Phone:603-747-9000
Mailing Address - Fax:603-747-0401
Practice Address - Street 1:90 SWIFTWATER ROAD
Practice Address - Street 2:COTTAGE HOSPITAL
Practice Address - City:WOODSVILLE
Practice Address - State:NH
Practice Address - Zip Code:03785-2001
Practice Address - Country:US
Practice Address - Phone:603-747-9000
Practice Address - Fax:603-747-0401
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH5745207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT77P010OtherPROVIDER ID
NH82114185Medicaid
VT0004185Medicaid
VTCOTT03993703OtherPROVIDER ID
NH0104185Y0NH03OtherPROVIDER ID
VT77P010OtherPROVIDER ID
NH82114185Medicaid