Provider Demographics
NPI:1508445826
Name:LIFEBRIDGE COMMUNITY PHYSICIANS INC
Entity Type:Organization
Organization Name:LIFEBRIDGE COMMUNITY PHYSICIANS INC
Other - Org Name:DR. BENJAMIN SCHULTZ
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 1:2700 QUARRY LAKE DR STE 220
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-3769
Mailing Address - Country:US
Mailing Address - Phone:410-469-5555
Mailing Address - Fax:410-469-4811
Practice Address - Street 1:2700 QUARRY LAKE DR STE 220
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-3769
Practice Address - Country:US
Practice Address - Phone:410-469-5555
Practice Address - Fax:410-469-4811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-05
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty