Provider Demographics
NPI:1235627225
Name:BEDFORD-LYON, NASTASSJA (MD)
Entity type:Individual
Prefix:DR
First Name:NASTASSJA
Middle Name:
Last Name:BEDFORD-LYON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:NASTASSJA
Other - Middle Name:
Other - Last Name:LYON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3000 ARLINGTON AVE STOP 1108
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-2595
Mailing Address - Country:US
Mailing Address - Phone:419-383-5023
Mailing Address - Fax:419-383-6235
Practice Address - Street 1:3125 TRANSVERSE DR STE F
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-8008
Practice Address - Country:US
Practice Address - Phone:419-383-6200
Practice Address - Fax:419-383-3244
Is Sole Proprietor?:No
Enumeration Date:2018-04-25
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301512223207N00000X
OH35.137505207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology