=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700734514
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIFEBRIDGE COMMUNITY PHYSICIANS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/18/2026
-----------------------------------------------------
Last Update Date | 03/18/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2470 LONGSTONE LN STE M
-----------------------------------------------------
City | MARRIOTTSVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21104-1515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-920-5550
-----------------------------------------------------
Fax | 443-920-5551
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2470 LONGSTONE LN STE M
-----------------------------------------------------
City | MARRIOTTSVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21104-1515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-920-5550
-----------------------------------------------------
Fax | 443-920-5551
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MARY REBECCA WRIGHT-SISK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 410-701-4439
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Y00000X
-----------------------------------------------------
Taxonomy Name | Otolaryngology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------