=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093700726
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOSEPH TIMOTHY LIFRAK MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/19/2005
-----------------------------------------------------
Last Update Date | 01/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 479 SWANSEA MALL DR
-----------------------------------------------------
City | SWANSEA
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02777-4119
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-973-1550
-----------------------------------------------------
Fax | 508-973-0386
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 MILL RD STE 180
-----------------------------------------------------
City | FAIRHAVEN
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02719-5255
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-973-2000
-----------------------------------------------------
Fax | 508-973-2001
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207XX0005X
-----------------------------------------------------
Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
-----------------------------------------------------
License Number | 261943
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207XX0005X
-----------------------------------------------------
Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
-----------------------------------------------------
License Number | MD09929
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------