# LIFEBRIDGE COMMUNITY PHYSICIANS INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** LifeBridge Suburban Physicians group LLC D/B/A Dr. Russell Schub at Old Court
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790585859
- **Authorized official:** MARY REBECCA WRIGHT-SISK (DIRECTOR)
- **Authorized official phone:** (443) 422-9941

## Contact information

- **Practice address:** 5401 OLD COURT RD, RANDALLSTOWN, MD 21133-5103
- **Practice address phone:** (410) 730-1000
- **Practice address fax:** (410) 730-2266
- **Mailing address:** 5401 OLD COURT RD, RANDALLSTOWN, MD 21133-5103
- **Mailing address phone:** (410) 730-1000
- **Mailing address fax:** (410) 730-2266

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RG0100X | Gastroenterology Physician | — | NULL | Yes |
| 207RG0100X | Gastroenterology Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/18/2025
- **Last updated:** 03/18/2025