Provider Demographics
NPI:1740287283
Name:LYONS, RICHARD C (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:C
Last Name:LYONS
Suffix:
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 1:389 E ALLEN ST
Mailing Address - Street 2:
Mailing Address - City:WINOOSKI
Mailing Address - State:VT
Mailing Address - Zip Code:05404-1560
Mailing Address - Country:US
Mailing Address - Phone:802-655-1314
Mailing Address - Fax:802-655-2895
Practice Address - Street 1:389 E ALLEN ST
Practice Address - Street 2:
Practice Address - City:WINOOSKI
Practice Address - State:VT
Practice Address - Zip Code:05404-1560
Practice Address - Country:US
Practice Address - Phone:802-655-1314
Practice Address - Fax:802-655-2895
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0005615207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0004622Medicaid
041092506OtherTRICARE
VT5293001OtherVERMONT MANAGED CARE
VTVT4622OtherVT BCBS
04V006OtherMVP
VTVT4622OtherVT BCBS