Provider Demographics
NPI:1093700726
Name:LIFRAK, JOSEPH TIMOTHY (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:TIMOTHY
Last Name:LIFRAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MILL RD STE 180
Mailing Address - Street 2:
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-5255
Mailing Address - Country:US
Mailing Address - Phone:508-973-2000
Mailing Address - Fax:508-973-2001
Practice Address - Street 1:479 SWANSEA MALL DR
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:MA
Practice Address - Zip Code:02777-4119
Practice Address - Country:US
Practice Address - Phone:508-973-1550
Practice Address - Fax:508-973-0386
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA261943207X00000X
RIMD09929207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI405507OtherCHIP
RI1093700726OtherDURABLE
RI32172-3OtherRI BLUE CROSS
RI7006971Medicaid
RI405507OtherCHIP
RI7006971Medicaid