Provider Demographics
NPI:1164884466
Name:LIFEBRIDGE HEALTH
Entity Type:Organization
Organization Name:LIFEBRIDGE HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:R
Authorized Official - Last Name:WRIGHT-SISK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-422-9941
Mailing Address - Street 1:8114 SANDPIPER CIR
Mailing Address - Street 2:SUITE 206
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-4934
Mailing Address - Country:US
Mailing Address - Phone:410-933-4923
Mailing Address - Fax:410-933-8659
Practice Address - Street 1:8114 SANDPIPER CIR
Practice Address - Street 2:SUITE 206
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-4934
Practice Address - Country:US
Practice Address - Phone:410-933-4923
Practice Address - Fax:410-933-8659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-25
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR204261261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty