Healthcare Provider Details

I. General information

NPI: 1518767201
Provider Name (Legal Business Name): LIFEBRIDGE COMMUNITY PHYSICIANS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2025
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 W ROLLING CROSS RD STE 100
CATONSVILLE MD
21228-6280
US

IV. Provider business mailing address

4 W ROLLING CROSS RD STE 100
CATONSVILLE MD
21228-6280
US

V. Phone/Fax

Practice location:
  • Phone: 410-869-0100
  • Fax: 410-601-6984
Mailing address:
  • Phone: 410-869-0100
  • Fax: 410-601-6984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

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