Organization
NORTHWEST HOSPITAL CENTER, INC.
Active
Parent organization
LIFEBRIDGE HEALTH, INC.
Other names
Northwest Medical Associates
Organization subpart
Yes
Provider details
NPI number
Legal business name
LIFEBRIDGE HEALTH, INC.
Authorized official
DAVID MCCORMICK (AVP)
(410) 701-4618
Entity
Organization
Contact information
Practice address
5401 OLD COURT RD, RANDALLSTOWN, MD 21133-5103
(410) 521-2200
Mailing address
5401 OLD COURT RD, ATTN: CREDENTIALING, RANDALLSTOWN, MD 21133-5103
(410) 601-5524
(410) 601-8946
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
03-004
MD
363A00000X
Physician Assistant
03-004
MD
363L00000X
Nurse Practitioner
03-004
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CN6601
R/R MEDICARE GROUP #
MD
Enumeration date
08/09/2006
Last updated
10/20/2021
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