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Organization
LIFEBRIDGE SUBURBAN PHYSICIAN GROUP II LLC
Active
Organization
LIFEBRIDGE SUBURBAN PHYSICIAN GROUP II LLC
Active
Parent organization
LIFEBRIDGE COMMUNITY PHYSICIANS, INC.
Other names
Dr. Jacalyn Blackwell-White
Organization subpart
Yes
Provider details
NPI number
Legal business name
LIFEBRIDGE COMMUNITY PHYSICIANS, INC.
Authorized official
MARY WRIGHT-SISK (DIRECTOR)
(443) 422-9941
Entity
Organization
Contact information
Practice address
5400 OLD COURT RD STE 300B, RANDALLSTOWN, MD 21133-5100
(410) 521-7337
(410) 521-7377
Mailing address
3527 N ROLLING RD, # 1, BALTIMORE, MD 21244-2223
(410) 521-7337
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
—
NULL
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
—
—
Other
Enumeration date
04/28/2016
Last updated
08/31/2021
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