Provider Demographics
NPI:1992723704
Name:LYONS, TIMOTHY R (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:R
Last Name:LYONS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 509
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03264-0509
Mailing Address - Country:US
Mailing Address - Phone:603-236-1568
Mailing Address - Fax:
Practice Address - Street 1:1 ELLIOT WAY STE 200
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-3502
Practice Address - Country:US
Practice Address - Phone:603-663-2315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2020-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH9814207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHAA34767OtherHARVARD PILGRIM
NH0106266Y0NH02OtherANTHEM
NH3072706Medicaid
NH8057117OtherCIGNA
VT1013775Medicaid
NH30204120Medicaid
NH0106266Y0NH02OtherANTHEM
NHAA34767OtherHARVARD PILGRIM
NHRE429701Medicare PIN