Provider Demographics
NPI:1447274303
Name:LYON, ROSS T (MD)
Entity type:Individual
Prefix:
First Name:ROSS
Middle Name:T
Last Name:LYON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:32 E 37TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-3008
Mailing Address - Country:US
Mailing Address - Phone:212-365-8788
Mailing Address - Fax:646-867-1550
Practice Address - Street 1:32 E 37TH ST
Practice Address - Street 2:SUITE M014
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-3008
Practice Address - Country:US
Practice Address - Phone:212-365-8788
Practice Address - Fax:646-867-1550
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1834652086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE07310Medicare UPIN
NYF32055Medicare UPIN