Provider Demographics
NPI:1497094809
Name:LIFEBRIDGE COMMUNITY PHYSICIANS, INC
Entity Type:Organization
Organization Name:LIFEBRIDGE COMMUNITY PHYSICIANS, INC
Other - Org Name:DRS. KROOPNICK & SHERMAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:R
Authorized Official - Last Name:WRIGHT-SISK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-701-4439
Mailing Address - Street 1:4000 OLD COURT RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-2800
Mailing Address - Country:US
Mailing Address - Phone:410-486-6300
Mailing Address - Fax:410-486-7200
Practice Address - Street 1:4000 OLD COURT RD
Practice Address - Street 2:SUITE 300
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-2800
Practice Address - Country:US
Practice Address - Phone:410-486-6300
Practice Address - Fax:410-486-7200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-05
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD218599Medicare PIN