Provider Demographics
NPI:1780691915
Name:LIFRAK, PATRICIA DINA (MD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:DINA
Last Name:LIFRAK
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 1:5 YORKLYN RIDGE
Mailing Address - Street 2:
Mailing Address - City:HOCKESSIN
Mailing Address - State:DE
Mailing Address - Zip Code:19707
Mailing Address - Country:US
Mailing Address - Phone:302-239-5450
Mailing Address - Fax:302-234-8267
Practice Address - Street 1:287 CHRISTIANA RD
Practice Address - Street 2:SUITE 8
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-2978
Practice Address - Country:US
Practice Address - Phone:302-325-6515
Practice Address - Fax:302-689-0122
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD042477E2084P0800X
DEC100037132084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000021561Medicaid
G02356P01Medicare PIN