Provider Demographics
NPI:1225653272
Name:LIFEBRIDGE COMMUNITY PHYSICIANS
Entity Type:Organization
Organization Name:LIFEBRIDGE COMMUNITY PHYSICIANS
Other - Org Name:DR. JOHN INGARI
Other - Org Type:Other Name
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:443-422-9941
Mailing Address - Street 1:10084 REISTERSTOWN RD STE 300A
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-4160
Mailing Address - Country:US
Mailing Address - Phone:410-521-2200
Mailing Address - Fax:410-601-4494
Practice Address - Street 1:1011 BALTIMORE BLVD
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-7055
Practice Address - Country:US
Practice Address - Phone:410-521-2200
Practice Address - Fax:410-601-4494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-15
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty