Basic Information
| Provider Information | |||||||||
| NPI: | 1538113659 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SIDDOWAY | ||||||||
| FirstName: | LYLE | ||||||||
| MiddleName: | AMOS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3421 CONCORD RD | ||||||||
| Address2: | |||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174029001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178512441 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 30 MONUMENT RD | ||||||||
| Address2: | SUITE 1100 | ||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174035024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7178512441 | ||||||||
| FaxNumber: | 7178513521 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2006 | ||||||||
| LastUpdateDate: | 05/11/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | MD044979E | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0001X | MD044979E | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology |
ID Information
| ID | Type | State | Issuer | Description | 20006623 | 01 | PA | AMERIHEALTH MERCY | OTHER | 577456 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 1521565 | 01 | PA | GATEWAY | OTHER | 7243 | 01 | PA | GEISINGER | OTHER | 01939210 | 01 | PA | CAPITAL BLUE CROSS | OTHER | 001190133 | 05 | PA | MEDICAID | 354482 | 01 | PA | CAREFIRST MD BLUE SHIELD | OTHER | 060013261 | 01 | PA | RAILROAD MEDICARE | OTHER | 086694 | 01 | PA | UNISON | OTHER |