Provider Demographics
NPI:1053124768
Name:LIFEBRIDGE COMMUNITY PHYSICIANS INC
Entity type:Organization
Organization Name:LIFEBRIDGE COMMUNITY PHYSICIANS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:REBECCA
Authorized Official - Last Name:WRIGHT-SISK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-623-8926
Mailing Address - Street 1:23 CROSSROADS DR STE 340
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5492
Mailing Address - Country:US
Mailing Address - Phone:410-653-0366
Mailing Address - Fax:410-601-4759
Practice Address - Street 1:23 CROSSROADS DR STE 340
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5492
Practice Address - Country:US
Practice Address - Phone:410-653-0366
Practice Address - Fax:410-601-4759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-28
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty