Healthcare Provider Details

I. General information

NPI: 1871580688
Provider Name (Legal Business Name): JOSEPH LAKE TRASK SR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 01/26/2024
Certification Date: 01/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10030 GILEAD RD STE 201
HUNTERSVILLE NC
28078-7545
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 704-887-4530
  • Fax: 704-887-4531
Mailing address:
  • Phone: 704-343-9800
  • Fax: 704-347-2011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number2011-01744
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number12800
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: