Healthcare Provider Details

I. General information

NPI: 1578956108
Provider Name (Legal Business Name): LIFEBRIDGE CARDIOLOGY OF PARKVILLE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2015
Last Update Date: 08/31/2021
Certification Date: 08/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 QUARRY LAKE DR SUITE 160
BALTIMORE MD
21209-3742
US

IV. Provider business mailing address

2700 QUARRY LAKE DR SUITE 160
BALTIMORE MD
21209-3742
US

V. Phone/Fax

Practice location:
  • Phone: 410-601-9355
  • Fax:
Mailing address:
  • Phone: 410-601-9355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number StateMD

VIII. Authorized Official

Name: MARY WRIGHT-SISK
Title or Position: DIRECTOR
Credential:
Phone: 443-422-9941