Basic Information
| Provider Information | |||||||||
| NPI: | 1710918560 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LYONS | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | JOYCE | ||||||||
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| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| OtherLastName: | JOYCE | ||||||||
| OtherFirstName: | MARY | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 9 INDUSTRIAL RD | ||||||||
| Address2: | STE 5 | ||||||||
| City: | MILFORD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017573736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5084731480 | ||||||||
| FaxNumber: | 5084731210 | ||||||||
| Practice Location | |||||||||
| Address1: | 835 W CENTRAL ST | ||||||||
| Address2: | |||||||||
| City: | FRANKLIN | ||||||||
| State: | MA | ||||||||
| PostalCode: | 020383188 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5085418000 | ||||||||
| FaxNumber: | 5085416749 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2006 | ||||||||
| LastUpdateDate: | 05/16/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 77531 | MA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 3111610 | 05 | MA | MEDICAID |