Organization
LIFEBRIDGE SUBURBAN PHYSICIANS GROUP, LLC
Active
Parent organization
LIFEBRIDGE COMMUNITY PHYSICIANS, LLC
Other names
Dr. Stephen Witanowski
Organization subpart
Yes
Provider details
NPI number
Legal business name
LIFEBRIDGE COMMUNITY PHYSICIANS, LLC
Authorized official
MRS. MARY WRIGHT-SISK (DIRECTOR OF PHYSICIAN ENTERPRISE)
(443) 422-9941
Entity
Organization
Contact information
Practice address
2700 QUARRY LAKE DR, SUITE 280, BALTIMORE, MD 21209-3742
(410) 469-5544
(410) 585-2867
Mailing address
5401 OLD COURT RD, RANDALLSTOWN, MD 21133-5103
(410) 701-4439
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
12/29/2015
Last updated
08/27/2021
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