Healthcare Provider Details

I. General information

NPI: 1407656192
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

8871 GORMAN RD
LAUREL MD
20723-5877
US

IV. Provider business mailing address

8871 GORMAN RD
LAUREL MD
20723-5877
US

V. Phone/Fax

Practice location:
  • Phone: 301-498-3150
  • Fax: 410-601-8886
Mailing address:
  • Phone: 301-498-3150
  • Fax: 410-601-8886

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