Healthcare Provider Details

I. General information

NPI: 1891247003
Provider Name (Legal Business Name): LIFEBRIDGE COMMUNITY PHYSICIANS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2016
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6190 GEORGETOWN BLVD STE 104
ELDERSBURG MD
21784-6460
US

IV. Provider business mailing address

6190 GEORGETOWN BLVD STE 104
ELDERSBURG MD
21784-6460
US

V. Phone/Fax

Practice location:
  • Phone: 410-552-5050
  • Fax: 410-552-0200
Mailing address:
  • Phone: 410-552-5050
  • Fax: 410-552-0200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

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