Basic Information
| Provider Information | |||||||||
| NPI: | 1336582238 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LIFEBRIDGE COMMUNITY PHYSICIANS, INC | ||||||||
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| OtherOrganizationName: | LIFEBRIDGE CARDIOLOGY OF BEL AIR LLC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 602 S ATWOOD RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | BEL AIR | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210144172 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 602 S ATWOOD RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | BEL AIR | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210144172 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106019355 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2013 | ||||||||
| LastUpdateDate: | 08/27/2021 | ||||||||
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| AuthorizedOfficialLastName: | WRIGHT-SISK | ||||||||
| AuthorizedOfficialFirstName: | MARY | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4434229941 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 08/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | MD | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.