Lifebridge Cardiology of Parkville, LLC

Primary specialty

Cardiovascular Disease PhysicianTaxonomy code 207RC0000X

Legal business name

LIFEBRIDGE CARDIOLOGY OF PARKVILLE, LLC

Practice address

12221 Tullamore Rd Ste 3
Lutherville, MD 21093-7816

Phone

(410) 308-7855

NPI assigned

Sep 22, 2014

Last updated

Jul 31, 2025By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mary Wright-Sisk

Title

Director

Phone

(443) 422-9941

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MD

Enrollment records 1

Tax ID family

Lifebridge Cardiology of Parkville LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

• Lifebridge Cardiology of Parkville, LLC

  • Cardiovascular Disease Physician
  • Randallstown, MD
  • NPI 1356144257
  NPD tax ID
• Lifebridge Cardiology of Parkville, LLC

  • Cardiovascular Disease Physician
  • Randallstown, MD
  • NPI 1467255364
  NPD tax ID
• Lifebridge Cardiology of Parkville, LLC

  dba Dr Jerald Insel

  • Cardiovascular Disease Physician
  • Baltimore, MD
  • NPI 1578956108
  NPD tax ID

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Lifebridge Community Physicians, Inc

  dba Dr Tahoora Kawaja

  • Internal Medicine Physician
  • Owings Mills, MD
  • NPI 1073940912

  Member Of

  NPD member

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ijaz A Khan, M.D.

  • Cardiovascular Disease Physician
  • Randallstown, MD
  • NPI 1851348155
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1411344000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753920000000",
    "number": "1013319011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12221 TULLAMORE RD STE 3",
            "city": "LUTHERVILLE",
            "state": "MD",
            "postal_code": "210937816",
            "telephone_number": "410-308-7855",
            "fax_number": "410-308-7856"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12221 TULLAMORE RD STE 3",
            "city": "LUTHERVILLE",
            "state": "MD",
            "postal_code": "210937816",
            "telephone_number": "410-308-7855"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5415 Old Court Rd",
            "address_2": "Suite 101",
            "address_purpose": "LOCATION",
            "city": "Randallstown",
            "state": "MD",
            "postal_code": "211335170",
            "country_code": "US",
            "telephone_number": "410-308-7855",
            "fax_number": "410-308-7856",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LIFEBRIDGE CARDIOLOGY OF PARKVILLE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-22",
        "last_updated": "2025-07-31",
        "certification_date": "2025-07-31",
        "status": "A",
        "authorized_official_last_name": "WRIGHT-SISK",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "443-422-9941"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MD",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Zhaobo Li, M.D., PH.D., L.AC.
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• Pei-Ting Lien, PT, DPT
• Life Fitness Physical Therapy of Towson, LLC
• Life Therapy Specialists of MD, LLC
• Lifebridge Community Physicians Inc
• Lifebridge Community Physicians Inc
• Lifebridge Community Physicians Inc
• Lifebridge Community Physicians, Inc (Drs Gouel, Blotny and Sullivan)
• Lifebridge Suburban Physician Group II, LLC (Dr. Gaurav Kumar)

• Cardiovascular Disease Physician in Lutherville, MD
• Providers in Lutherville, MD by specialty
• Cardiovascular Disease Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.