Healthcare Provider Details

I. General information

NPI: 1174815807
Provider Name (Legal Business Name): LIFEBRIDGE COMMUNITY PHYSICIANS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2011
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 YORK RD STE 20
TIMONIUM MD
21093-6211
US

IV. Provider business mailing address

1205 YORK RD STE 20
TIMONIUM MD
21093-6211
US

V. Phone/Fax

Practice location:
  • Phone: 410-469-4000
  • Fax: 410-653-1296
Mailing address:
  • Phone: 410-469-4000
  • Fax: 410-653-1296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

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