Healthcare Provider Details

I. General information

NPI: 1003251851
Provider Name (Legal Business Name): DANA S LYCANS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2013
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 3RD AVE
HUNTINGTON WV
25703-1225
US

IV. Provider business mailing address

2211 3RD AVE
HUNTINGTON WV
25703-1225
US

V. Phone/Fax

Practice location:
  • Phone: 304-691-1880
  • Fax: 304-691-1881
Mailing address:
  • Phone: 304-691-1880
  • Fax: 304-691-1881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number26378
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD.36818
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number26378
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: