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
1	207R00000X	Internal Medicine Physician		MD

General Provider Information

NPI Number	:	1851768493
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFEBRIDGE COMMUNITY PHYSICIANS, INC

Provider Business Mailing Address
First Line	:	12221 TULLAMORE RD
Second Line	:
City	:	LUTHERVILLE TIMONIUM
State	:	MD
Zip	:	21093-7816
Country	:	US
Telephone Number	:	410-308-7840
Fax Number	:	410-308-7841

Provider Business Practice Location Address
First Line	:	12221 TULLAMORE RD
Second Line	:
City	:	LUTHERVILLE TIMONIUM
State	:	MD
Zip	:	21093-7816
Country	:	US
Telephone Number	:	410-308-7840
Fax Number	:	410-308-7841

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MARY R WRIGHT-SISK
Credential	:
Telephone Number	:	443-422-9941

Provider Enumeration Date	:	08/31/2015
Last Update Date	:	08/27/2021

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Directions to “LIFEBRIDGE COMMUNITY PHYSICIANS, INC ” Practice Location

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