# LIFE LINE CORPORATION -4 LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639821648
- **Authorized official:** KAMAL G. BANGORIA MD (PRESIDENT)
- **Authorized official phone:** (443) 255-3951

## Contact information

- **Practice address:** 349 MALCOLM DR, WESTMINSTER, MD 21157-6106
- **Practice address phone:** (410) 848-2566
- **Mailing address:** 1798 ODEN WAY, ELDERSBURG, MD 21784-7095
- **Mailing address phone:** (443) 255-3951

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |
| 208M00000X | Hospitalist Physician | — | NULL | — |
| 208M00000X | Hospitalist Physician | — | — | — |

## Other

- **Enumeration date:** 01/20/2022
- **Last updated:** 09/10/2025