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NPI Code Detail

MEDICARE: LIFEBRIDGE COMMUNITY PHYSICIANS, INC

MEDICARE: LIFEBRIDGE COMMUNITY PHYSICIANS, INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine PhysicianMD

General Provider Information

NPI Number : 1093141616
Entity Type Code : Organization
Provider Name (Legal Business Name) : LIFEBRIDGE COMMUNITY PHYSICIANS, INC
Provider Business Mailing Address
First Line : 1011 BALTIMORE BLVD
Second Line : DR ALEXANDER BOGDASCHEWSKYI
City : WESTMINSTER
State : MD
Zip : 21157-7055
Country : US
Telephone Number : 410-848-8256
Fax Number : 410-848-5950
Provider Business Practice Location Address
First Line : 1011 BALTIMORE BLVD
Second Line : DR ALEXANDER BOGDASCHEWSKYI
City : WESTMINSTER
State : MD
Zip : 21157-7055
Country : US
Telephone Number : 410-848-8256
Fax Number : 410-848-5950
Authorized Official
Title or Position : DIRECTOR
Name : MARY WRIGHT-SISK
Credential :
Telephone Number : 443-422-9941
Provider Enumeration Date : 09/16/2013
Last Update Date : 08/27/2021

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Directions to “LIFEBRIDGE COMMUNITY PHYSICIANS, INC ” Practice Location

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