Healthcare Provider Details

I. General information

NPI: 1588093652
Provider Name (Legal Business Name): LIFEBRIDGE COMMUNITY PHYSICIANS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2013
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 OLD COURT RD STE 300B
RANDALLSTOWN MD
21133-5126
US

IV. Provider business mailing address

5400 OLD COURT RD STE 300B
RANDALLSTOWN MD
21133-5126
US

V. Phone/Fax

Practice location:
  • Phone: 410-521-7337
  • Fax: 410-521-7377
Mailing address:
  • Phone: 410-521-7337
  • Fax: 410-521-7377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MARY WRIGHT-SISK
Title or Position: DIRECTOR
Credential: M.D.
Phone: 443-422-9941