Basic Information
Provider Information
NPI: 1235517509
EntityType: 2
ReplacementNPI:  
OrganizationName: LIFEBRIDGE COMMUNITY PHYSICIANS, INC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: DR JOHN DOWNS
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 12221 TULLAMORE RD
Address2:  
City: LUTHERVILLE TIMONIUM
State: MD
PostalCode: 210937816
CountryCode: US
TelephoneNumber: 4106019355
FaxNumber:  
Practice Location
Address1: 12221 TULLAMORE RD
Address2:  
City: LUTHERVILLE TIMONIUM
State: MD
PostalCode: 210937816
CountryCode: US
TelephoneNumber: 4106019355
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/07/2015
LastUpdateDate: 08/27/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: WRIGHT-SISK
AuthorizedOfficialFirstName: MARY
AuthorizedOfficialMiddleName: R
AuthorizedOfficialTitleorPosition: DIRECTOR
AuthorizedOfficialTelephone: 4434229941
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: M.D.
NPICertificationDate: 08/27/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RH0003X  Y193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology

No ID Information.


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