Basic Information
| Provider Information | |||||||||
| NPI: | 1114909009 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LYONS | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | PATRICK | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 785 5TH AVE | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172014232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172639555 | ||||||||
| FaxNumber: | 7172174218 | ||||||||
| Practice Location | |||||||||
| Address1: | 120 N 7TH ST STE 101 | ||||||||
| Address2: | |||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172011795 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172631220 | ||||||||
| FaxNumber: | 7172636255 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2005 | ||||||||
| LastUpdateDate: | 09/10/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 2004-00374 | NC | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | MD048632L | PA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | N74004 | 05 | SC | MEDICAID | 104274NZ3 | 01 | PA | MEDICARE HERSHEY | OTHER | 891363A | 05 | NE | MEDICAID | 101700481 | 05 | PA | MEDICAID | 101700481 0001 | 01 | PA | MEDICAID HERSHEY | OTHER |