Healthcare Provider Details

I. General information

NPI: 1760864870
Provider Name (Legal Business Name): LIFEBRIDGE COMMUNITY PHYSICIANS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2015
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 QUARRY LAKE DR STE 160
BALTIMORE MD
21209-3743
US

IV. Provider business mailing address

2700 QUARRY LAKE DR STE 160
BALTIMORE MD
21209-3743
US

V. Phone/Fax

Practice location:
  • Phone: 410-933-4923
  • Fax: 410-933-8659
Mailing address:
  • Phone: 410-933-4923
  • Fax: 410-933-8659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number StateMD

VIII. Authorized Official

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