Healthcare Provider Details

I. General information

NPI: 1003182270
Provider Name (Legal Business Name): CAROLINE ELMER-LYON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2012
Last Update Date: 07/11/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 MEDICAL VILLAGE DR
EDGEWOOD KY
41017-3416
US

IV. Provider business mailing address

PO BOX 635283
CINCINNATI OH
45263-5283
US

V. Phone/Fax

Practice location:
  • Phone: 859-757-3132
  • Fax: 859-301-7010
Mailing address:
  • Phone: 859-757-2132
  • Fax: 859-301-7010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number01082014A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number52657
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: