Healthcare Provider Details

I. General information

NPI: 1407846702
Provider Name (Legal Business Name): CAROL ANN LYONS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 EAST 2ND ST 5TH FLOOR
ERIE PA
16507
US

IV. Provider business mailing address

717 STATE ST SUITE 16 LL
ERIE PA
16501
US

V. Phone/Fax

Practice location:
  • Phone: 814-838-0990
  • Fax: 814-838-0994
Mailing address:
  • Phone: 814-480-7100
  • Fax: 814-480-7604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD027535E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: