Healthcare Provider Details

I. General information

NPI: 1821898511
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: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 BAUGHMANS LN STE 270
FREDERICK MD
21702-4650
US

IV. Provider business mailing address

110 BAUGHMANS LN STE 270
FREDERICK MD
21702-4650
US

V. Phone/Fax

Practice location:
  • Phone: 301-846-0300
  • Fax: 410-601-4938
Mailing address:
  • Phone: 301-846-0300
  • Fax: 410-601-4938

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