Healthcare Provider Details

I. General information

NPI: 1841036357
Provider Name (Legal Business Name): LIFEBRIDGE ORTHOPEDIC SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2024
Last Update Date: 07/03/2024
Certification Date: 07/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

844 WASHINGTON RD
WESTMINSTER MD
21157-6664
US

IV. Provider business mailing address

844 WASHINGTON RD STE 102
WESTMINSTER MD
21157-6664
US

V. Phone/Fax

Practice location:
  • Phone: 410-578-1094
  • Fax:
Mailing address:
  • Phone: 410-578-1094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: CARY MILLER
Title or Position: CREDENTIALING ANALYST
Credential:
Phone: 410-871-6831