Healthcare Provider Details

I. General information

NPI: 1902808702
Provider Name (Legal Business Name): CHRISTOPHER D. LYONS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 06/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 WADSWORTH DR
RICHMOND VA
23236-4521
US

IV. Provider business mailing address

223 WADSWORTH DR
RICHMOND VA
23236-4510
US

V. Phone/Fax

Practice location:
  • Phone: 804-330-4901
  • Fax: 804-330-9141
Mailing address:
  • Phone: 804-560-9856
  • Fax: 804-330-4131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number0101102586
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: