Healthcare Provider Details

I. General information

NPI: 1295744191
Provider Name (Legal Business Name): PATRICIA D LIFRAK MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 07/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

287 CHRISTIANA RD SUITE 8
NEW CASTLE DE
19720-2978
US

IV. Provider business mailing address

5 YORKRIDGE TRAIL
HOCKESSIN DE
19707
US

V. Phone/Fax

Practice location:
  • Phone: 302-328-4392
  • Fax: 302-689-0122
Mailing address:
  • Phone: 302-328-4392
  • Fax: 302-689-0122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberC1-0003713
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberC10003713
License Number StateDE

VIII. Authorized Official

Name: PATRICIA D LIFRAK
Title or Position: PRESIDENT
Credential: MD
Phone: 302-328-4392