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General NPI Number Information
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NPI Number | 1073401972
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Entity Type | Organization
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Legal Business Name | LIFEBRIDGE COMMUNITY PHYSICIANS INC
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Dates
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Enumeration Date | 06/27/2025
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Last Update Date | 06/27/2025
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Provider Practice Location Address
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Address Line | 4991 NEW DESIGN RD STE 103
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City | FREDERICK
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State | MD
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Zip | 21703-7342
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Country | US
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Telephone | 443-289-3459
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Fax | 443-289-3488
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Provider Business Mailing Address
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Address Line | 4991 NEW DESIGN RD STE 103
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City | FREDERICK
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State | MD
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Zip | 21703-7342
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Country | US
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Telephone | 443-289-3459
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Fax | 443-289-3488
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Authorized Official
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Title or Position | DIRECTOR
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Name | MARY REBECCA WRIGHT-SISK
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Credential |
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Telephone | 434-229-9414
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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License Number State |
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