Healthcare Provider Details

I. General information

NPI: 1366233611
Provider Name (Legal Business Name): LIFEBRIDGE COMMUNITY PHYSICIANS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2025
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10084 REISTERSTOWN RD STE 200A
OWINGS MILLS MD
21117-4096
US

IV. Provider business mailing address

10084 REISTERSTOWN RD STE 200A
OWINGS MILLS MD
21117-4096
US

V. Phone/Fax

Practice location:
  • Phone: 410-552-5050
  • Fax: 410-356-7505
Mailing address:
  • Phone: 410-552-5050
  • Fax: 410-356-7505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

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