Healthcare Provider Details

I. General information

NPI: 1679407316
Provider Name (Legal Business Name): LIFEBRIDGE ANESTHESIA ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 CROSSROADS DR STE 100
OWINGS MILLS MD
21117-5476
US

IV. Provider business mailing address

10090 RED RUN BLVD FL 3
OWINGS MILLS MD
21117-4827
US

V. Phone/Fax

Practice location:
  • Phone: 410-356-0300
  • Fax:
Mailing address:
  • Phone: 410-601-4832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: LAURA CHRISTINE CALLAHAN
Title or Position: COMPLIANCE OFFICER
Credential:
Phone: 410-601-4832