Provider Demographics
NPI:1588769459
Name:LYONS, JONATHAN SPENCER (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:SPENCER
Last Name:LYONS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:8630 FENTON ST
Mailing Address - Street 2:#514
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3806
Mailing Address - Country:US
Mailing Address - Phone:301-587-1220
Mailing Address - Fax:301-587-1269
Practice Address - Street 1:8630 FENTON ST
Practice Address - Street 2:#514
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3806
Practice Address - Country:US
Practice Address - Phone:301-587-1220
Practice Address - Fax:301-587-1269
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2014-06-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0013975207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD212311800Medicaid
MD212311800Medicaid
MDC61705Medicare UPIN
MD4787870001Medicare NSC