Healthcare Provider Details

I. General information

NPI: 1346003266
Provider Name (Legal Business Name): LIFEGATE GLOBAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2024
Last Update Date: 02/02/2024
Certification Date: 02/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5430 CAMPBELL BLVD STE 208
NOTTINGHAM MD
21236
US

IV. Provider business mailing address

5430 CAMPBELL BLVD STE 208
NOTTINGHAM MD
21236
US

V. Phone/Fax

Practice location:
  • Phone: 443-823-5066
  • Fax:
Mailing address:
  • Phone: 443-823-5066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: ZHENSHENG LI
Title or Position: CEO
Credential: MD PHD
Phone: 443-823-5066