Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223E0200X | Endodontist | 13970 | MA |
Y | 1223E0200X | Endodontist | 1844 | NH |
NPI | 1104869809 |
---|---|
Provider Name | Dr. Marilyn S Lyons |
First Address | Londonderry, NH 03053 |
Second Address | Londonderry, NH 03053 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2006 |
Last Update Date | 27/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
X12134 | BC/BS OF MA PROVIDER # (01) | NH |
X12135 | BC/BS OF MA PROVIDER # (01) | MA |