MEDICARE: DR. LYLE AMOS SIDDOWAY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	MD044979E	PA
2	207RC0001X	Clinical Cardiac Electrophysiology Physician	MD044979E	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
8	060013261	OTHER	PA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	20006623	OTHER	PA	AMERIHEALTH MERCY
2	577456	OTHER	PA	HIGHMARK BLUE SHIELD
3	1521565	OTHER	PA	GATEWAY
4	7243	OTHER	PA	GEISINGER
5	01939210	OTHER	PA	CAPITAL BLUE CROSS
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	354482	OTHER	PA	CAREFIRST MD BLUE SHIELD
9	086694	OTHER	PA	UNISON

General Provider Information

NPI Number	:	1538113659
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LYLE AMOS SIDDOWAY MD

Provider Business Mailing Address
First Line	:	3421 CONCORD RD
Second Line	:
City	:	YORK
State	:	PA
Zip	:	17402-9001
Country	:	US
Telephone Number	:	717-851-2441
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 MONUMENT RD
Second Line	:	SUITE 1100
City	:	YORK
State	:	PA
Zip	:	17403-5024
Country	:	US
Telephone Number	:	717-851-2441
Fax Number	:	717-851-3521

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	05/11/2021

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