MEDICARE: LIFEBRIDGE COMMUNITY PHYSICIANS, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician		MD

General Provider Information

NPI Number	:	1225428915
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFEBRIDGE COMMUNITY PHYSICIANS, INC

Provider Business Mailing Address
First Line	:	1011 BALTIMORE BLVD
Second Line	:
City	:	WESTMINSTER
State	:	MD
Zip	:	21157-7055
Country	:	US
Telephone Number	:	410-461-5001
Fax Number	:	410-469-5003

Provider Business Practice Location Address
First Line	:	1011 BALTIMORE BLVD
Second Line	:
City	:	WESTMINSTER
State	:	MD
Zip	:	21157-7055
Country	:	US
Telephone Number	:	410-461-5001
Fax Number	:	410-469-5003

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MARY WRIGHT-SISK
Credential	:
Telephone Number	:	410-623-8926

Provider Enumeration Date	:	02/02/2015
Last Update Date	:	09/28/2022

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Directions to “LIFEBRIDGE COMMUNITY PHYSICIANS, INC ” Practice Location

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