Healthcare Provider Details

I. General information

NPI: 1841696697
Provider Name (Legal Business Name): LIFEBRIDGE ORTHOPEDIC SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2014
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5051 GREENSPRING AVE STE 200
BALTIMORE MD
21209-4357
US

IV. Provider business mailing address

5051 GREENSPRING AVE STE 200
BALTIMORE MD
21209-4357
US

V. Phone/Fax

Practice location:
  • Phone: 410-601-9000
  • Fax:
Mailing address:
  • Phone: 410-601-9515
  • Fax: 410-601-1543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number StateMD

VIII. Authorized Official

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