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General NPI Number Information
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NPI Number | 1588093652
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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 | 11/08/2013
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Last Update Date | 08/01/2025
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Provider Practice Location Address
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Address Line | 5400 OLD COURT RD STE 300B
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City | RANDALLSTOWN
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State | MD
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Zip | 21133-5126
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Country | US
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Telephone | 410-521-7337
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Fax | 410-521-7377
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Provider Business Mailing Address
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Address Line | 5400 OLD COURT RD STE 300B
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City | RANDALLSTOWN
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State | MD
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Zip | 21133-5126
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Country | US
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Telephone | 410-521-7337
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Fax | 410-521-7377
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Authorized Official
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Title or Position | DIRECTOR
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Name | MARY WRIGHT-SISK
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Credential | M.D.
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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 | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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