1295744191 NPI number — PATRICIA D LIFRAK MD INC

Table of content: (NPI 1295744191)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295744191 NPI number — PATRICIA D LIFRAK MD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PATRICIA D LIFRAK MD INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295744191
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/09/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5 YORKRIDGE TRAIL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOCKESSIN
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19707
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-328-4392
Provider Business Mailing Address Fax Number:
302-689-0122

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
287 CHRISTIANA RD
Provider Second Line Business Practice Location Address:
SUITE 8
Provider Business Practice Location Address City Name:
NEW CASTLE
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19720-2978
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-328-4392
Provider Business Practice Location Address Fax Number:
302-689-0122
Provider Enumeration Date:
08/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LIFRAK
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
302-328-4392

Provider Taxonomy Codes

  • Taxonomy code: 2084A0401X , with the licence number:  C1-0003713 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084A0401X , with the licence number: C10003713 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1000021561 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00367274 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".




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