# LIFEBRIDGE COMMUNITY PHYSICIANS INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** LifeBridge Health Primary Care of Baltimore
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417757279
- **Authorized official:** MARY REBECCA WRIGHT-SISK (DIRECTOR)
- **Authorized official phone:** (443) 422-9941

## Contact information

- **Practice address:** 711 W 40TH ST STE 212A, BALTIMORE, MD 21211-2108
- **Practice address phone:** (410) 601-0071
- **Practice address fax:** (410) 601-0290
- **Mailing address:** 711 W 40TH ST STE 212A, BALTIMORE, MD 21211-2108
- **Mailing address phone:** (410) 601-0071
- **Mailing address fax:** (410) 601-0290

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/19/2025
- **Last updated:** 03/19/2025