Provider Demographics
NPI:1134529779
Name:LIFEBRIDGE GYNECOLOGY OF PIKESVILLE, LLC
Entity type:Organization
Organization Name:LIFEBRIDGE GYNECOLOGY OF PIKESVILLE, LLC
Other - Org Name:
Other - Org Type:
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:410-521-2200
Mailing Address - Street 1:4000 OLD COURT RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-2800
Mailing Address - Country:US
Mailing Address - Phone:410-653-0000
Mailing Address - Fax:410-653-5531
Practice Address - Street 1:4000 OLD COURT RD
Practice Address - Street 2:SUITE 301
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-2800
Practice Address - Country:US
Practice Address - Phone:410-653-0000
Practice Address - Fax:410-653-5531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-02
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty