NPIMap

Organization Active NPI

Lifebridge Medical Associates, LLC

Doing business as Crossroads Medical Group

  • Internal Medicine Physician
  • Ellicott City, MD
National Provider Identifier
1124433628
Registry record updated Aug 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
LIFEBRIDGE MEDICAL ASSOCIATES, LLC
Practice address
4801 Dorsey Hall Dr Ste 201
Ellicott City, MD 21042-7749
Phone
(410) 997-5191
Fax
(410) 997-7957
NPI assigned
Jun 24, 2014
Last updated
Aug 17, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2026

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

Authorized official

Name
Joel Suldan
Title
Vice President
Phone
(410) 601-5129

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X MD Primary

Addresses

Primary practice location

4801 Dorsey Hall Dr Ste 201
Ellicott City, MD 21042-7749

Mailing address

4801 Dorsey Hall Dr Ste 201
Ellicott City, MD 21042-7749
Phone (410) 997-5191

Other names 1

  • Crossroads Medical group Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20141001001162 MD Part B Supplier - Physical/Occupational Therapy Group in Private Practice 0446470165 Receives reassigned benefits from 25 practitioners
Practice locations: Ellicott City, MD

National Provider Directory

National Provider Directory

Member of 1

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

Locations

4801 Dorsey Hall Dr
#G
Ellicott City, MD 21042
Phone (443) 393-3788

4801 Dorsey Hall Dr
Ste 201
Ellicott City, MD 21042
Phone (410) 997-5191

Practitioners & affiliated clinicians

Practitioners 25

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.

View all 25

NPI Registry JSON

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

{
    "created_epoch": "1403568000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1786924800000",
    "number": "1124433628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4801 DORSEY HALL DR STE 201",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210427749",
            "telephone_number": "410-997-5191",
            "fax_number": "410-997-7957"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4801 DORSEY HALL DR STE 201",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210427749",
            "telephone_number": "410-997-5191",
            "fax_number": "410-997-7957"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFEBRIDGE MEDICAL ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-24",
        "last_updated": "2026-08-17",
        "certification_date": "2026-08-17",
        "status": "A",
        "authorized_official_last_name": "SULDAN",
        "authorized_official_first_name": "JOEL",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "410-601-5129"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "MD",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crossroads Medical Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Crossroads Medical group",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Ellicott City, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2026; 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.