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General NPI Number Information
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NPI Number | 1851873970
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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 | 09/05/2018
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Last Update Date | 08/27/2021
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Provider Practice Location Address
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Address Line | 711 W. 40TH STREET SUITE 212A
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City | BALTIMORE
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State | MD
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Zip | 21211
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Country | US
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Telephone | 202-270-0099
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Fax |
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Provider Business Mailing Address
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Address Line | 711 W. 40TH STREET SUITE 212A
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City | BALTIMORE
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State | MD
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Zip | 21211
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. 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 | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | D60351
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License Number State | MD
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