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	207R00000X	Internal Medicine Physician
2	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1366233611
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFEBRIDGE COMMUNITY PHYSICIANS INC

Provider Business Mailing Address
First Line	:	10084 REISTERSTOWN RD STE 200A
Second Line	:
City	:	OWINGS MILLS
State	:	MD
Zip	:	21117-4096
Country	:	US
Telephone Number	:	410-552-5050
Fax Number	:	410-356-7505

Provider Business Practice Location Address
First Line	:	10084 REISTERSTOWN RD STE 200A
Second Line	:
City	:	OWINGS MILLS
State	:	MD
Zip	:	21117-4096
Country	:	US
Telephone Number	:	410-552-5050
Fax Number	:	410-356-7505

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MARY REBECCA WRIGHT-SISK
Credential	:
Telephone Number	:	443-422-9941

Provider Enumeration Date	:	05/15/2025
Last Update Date	:	03/24/2026

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