Provider Demographics
NPI:1578956108
Name:LIFEBRIDGE CARDIOLOGY OF PARKVILLE, LLC
Entity Type:Organization
Organization Name:LIFEBRIDGE CARDIOLOGY OF PARKVILLE, LLC
Other - Org Name:DR JERALD INSEL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
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
Mailing Address - Street 2:SUITE 160
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-3742
Mailing Address - Country:US
Mailing Address - Phone:410-601-9355
Mailing Address - Fax:
Practice Address - Street 1:2700 QUARRY LAKE DR
Practice Address - Street 2:SUITE 160
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-3742
Practice Address - Country:US
Practice Address - Phone:410-601-9355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFEBRIDGE COMMUNITY PHYSICIANS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-03-06
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty