Provider Demographics
NPI:1477587624
Name:TRASK, LORI L (MD)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:L
Last Name:TRASK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 CHESTNUT ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01199-1001
Mailing Address - Country:US
Mailing Address - Phone:413-794-5700
Mailing Address - Fax:
Practice Address - Street 1:40 WRIGHT ST
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:MA
Practice Address - Zip Code:01069-1138
Practice Address - Country:US
Practice Address - Phone:413-967-2040
Practice Address - Fax:413-967-2044
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA75439208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA30006531Medicaid
984990OtherNETWORK HEALTH
762251OtherHARVARD PILGRIM
762251OtherCONNECTICARE
50102OtherFALLON COMMUNITY HEALTH P
4390320OtherHEALTHSOURCE CMHC
F40519Medicare UPIN
1200877OtherUNITED HEALTH CARE
J13052Medicare ID - Type Unspecified
J13052OtherBLUE CROSS BLUE SHIELD
075439OtherTUFTS COMMUNITY HEALTH PL