1255434551 NPI number — GERALD J LYONS JR. MD

Table of content: GERALD J LYONS JR. MD (NPI 1255434551)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255434551 NPI number — GERALD J LYONS JR. MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LYONS
Provider First Name:
GERALD
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
JR.
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255434551
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
90 SWIFTWATER ROAD
Provider Second Line Business Mailing Address:
COTTAGE HOSPITAL
Provider Business Mailing Address City Name:
WOODSVILLE
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03785-2001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-747-9000
Provider Business Mailing Address Fax Number:
603-747-0401

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
90 SWIFTWATER ROAD
Provider Second Line Business Practice Location Address:
COTTAGE HOSPITAL
Provider Business Practice Location Address City Name:
WOODSVILLE
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03785-2001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-747-9000
Provider Business Practice Location Address Fax Number:
603-747-0401
Provider Enumeration Date:
09/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  5745 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 77P010 . This is a "PROVIDER ID" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 82114185 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0004185 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: COTT03993703 . This is a "PROVIDER ID" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 0104185Y0NH03 . This is a "PROVIDER ID" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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