Healthcare Provider Details

I. General information

NPI: 1700719127
Provider Name (Legal Business Name): LIFEBRIDGE COMMUNITY PHYSICIANS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 E RIDGEVILLE BLVD STE 110
MOUNT AIRY MD
21771-5942
US

IV. Provider business mailing address

504 E RIDGEVILLE BLVD STE 110
MOUNT AIRY MD
21771-5942
US

V. Phone/Fax

Practice location:
  • Phone: 410-521-2200
  • Fax: 410-601-4494
Mailing address:
  • Phone: 410-521-2200
  • Fax: 410-601-4494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number
License Number State

VIII. Authorized Official

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