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General NPI Number Information
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NPI Number | 1093205841
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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 | 05/17/2018
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Last Update Date | 03/19/2025
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Provider Practice Location Address
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Address Line | 10084 REISTERSTOWN RD SUITE 300A
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City | OWINGS MILLS
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State | MD
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Zip | 21117
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Country | US
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Telephone | 667-219-6313
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Fax | 443-815-4706
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Provider Business Mailing Address
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Address Line | 10084 REISTERSTOWN RD SUITE 300A
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City | OWINGS MILLS
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State | MD
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Zip | 21117
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Country | US
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Telephone | 667-219-6313
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Fax | 443-815-4706
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Authorized Official
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Title or Position | DIRECTOR
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Name | MARY R WRIGHT-SISK
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Credential | MD
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Telephone | 443-422-9941
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | D0060491
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 207XS0114X
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Taxonomy Name | Adult Reconstructive Orthopaedic Surgery Physician
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License Number | D0060491
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 207XX0801X
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Taxonomy Name | Orthopaedic Trauma Physician
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License Number | D0060491
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License Number State | MD
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Taxonomy #4
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | D0060491
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License Number State | MD
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