Basic Information
| Provider Information | |||||||||
| NPI: | 1043278385 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LYON-LOFTUS | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | T | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PH.D. M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 785 5TH AVENUE | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172014232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172639555 | ||||||||
| FaxNumber: | 7172624217 | ||||||||
| Practice Location | |||||||||
| Address1: | 6155 ANTHONY HIGHWAY | ||||||||
| Address2: | |||||||||
| City: | WAYNESBORO | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172689718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177493181 | ||||||||
| FaxNumber: | 7177493191 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2006 | ||||||||
| LastUpdateDate: | 04/01/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD030928E | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207QH0002X | MD030928E | PA | N | Allopathic & Osteopathic Physicians | Family Medicine | Hospice and Palliative Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000970434 0003 | 05 | PA | MEDICAID | 120420417 | 01 | PA | DEPT OF LABOR | OTHER | 25-1716306 | 01 | PA | SOUTH CENTRAL PREFERRED | OTHER | 25-1716306 | 01 | PA | MULTIPLAN/PHCS | OTHER | AL2727800 | 01 | PA | DEA | OTHER | P00468816 | 01 | PA | RAILROAD MEDICARE | OTHER | 25-1716306 | 01 | PA | DEVON | OTHER | 50074258 | 01 | PA | CAPITAL BLUECROSS | OTHER | 226900 | 01 | PA | UNISON | OTHER | 4601928 | 01 | PA | AETNA NON-HMO | OTHER | 098297 | 01 | PA | HIGHMARK BLUESHIELD | OTHER | 1007307260034 | 01 | PA | MEDICAID GROUP # | OTHER | 715056 | 01 | PA | HEALTH AMERICA | OTHER | 844639 | 01 | PA | AETNA HMO | OTHER | 25-1716306 | 01 | PA | HEALTHNET/TRICARE | OTHER | MD030928E | 01 | PA | LICENSE | OTHER | 25-1716306 | 01 | PA | INTERGROUP | OTHER | P008956 | 01 | PA | GATEWAY | OTHER | 25-1716306 | 01 | PA | INFORMED | OTHER | 867633 | 01 | PA | MEDICARE GROUP # | OTHER | G920-0083/KDM4CU | 01 | PA | CAREFIRST | OTHER |