NPIMap

Organization Active NPI

Lifebridge Suburban Physician Group II LLC

  • Pediatrics Physician
  • Baltimore, MD
National Provider Identifier
1104617422
Registry record updated May 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
LIFEBRIDGE SUBURBAN PHYSICIAN GROUP II LLC
Practice address
6701 N Charles St
Baltimore, MD 21204-6808
Phone
(410) 308-7865
Fax
(410) 308-7818
NPI assigned
May 15, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 15, 2025

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

Authorized official

Name
Mary Rebecca Wright-Sisk
Title
Director
Phone
(443) 422-9941

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

6701 N Charles St
Baltimore, MD 21204-6808

Mailing address

6701 N Charles St
Baltimore, MD 21204-6808
Phone (410) 308-7865

Other names 1

  • Dr. Gaurav Kumar at N Charles Other name

National Provider Directory

National Provider Directory
Tax ID family
Dr Gaurav Kumar7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

NPI Registry JSON

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

{
    "created_epoch": "1747267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747267200000",
    "number": "1104617422",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6701 N CHARLES ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212046808",
            "telephone_number": "410-308-7865",
            "fax_number": "410-308-7818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6701 N CHARLES ST",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212046808",
            "telephone_number": "410-308-7865",
            "fax_number": "410-308-7818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFEBRIDGE SUBURBAN PHYSICIAN GROUP II LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-05-15",
        "last_updated": "2025-05-15",
        "certification_date": "2025-05-15",
        "status": "A",
        "authorized_official_last_name": "WRIGHT-SISK",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "REBECCA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "443-422-9941"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dr. Gaurav Kumar at N Charles",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.