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General NPI Number Information
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NPI Number | 1225653272
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Entity Type | Organization
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Legal Business Name | LIFEBRIDGE COMMUNITY PHYSICIANS
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Dates
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Enumeration Date | 06/15/2020
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Last Update Date | 05/31/2022
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Provider Practice Location Address
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Address Line | 1011 BALTIMORE BLVD
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City | WESTMINSTER
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State | MD
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Zip | 21157-7055
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Country | US
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Telephone | 410-521-2200
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Fax | 410-601-4494
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Provider Business Mailing Address
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Address Line | 10084 REISTERSTOWN RD STE 300A
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City | OWINGS MILLS
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State | MD
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Zip | 21117-4160
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Country | US
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Telephone | 410-521-2200
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Fax | 410-601-4494
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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 | 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 |
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License Number State |
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