Lifebridge Suburban Physicians Group, LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

LIFEBRIDGE SUBURBAN PHYSICIANS GROUP, LLC

Doing business as

Dr. Stephen Witanowski

Practice address

2700 Quarry Lake Dr
Suite 280
Baltimore, MD 21209-3742

Phone

(410) 469-5544

Fax

(410) 585-2867

NPI assigned

Dec 29, 2015

Last updated

Aug 27, 2021By the provider in NPPES

Organization subpart

Yes

Parent organization

LIFEBRIDGE COMMUNITY PHYSICIANS, LLCAs reported in NPPES

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

Authorized official

Name

Mrs. Mary Wright-Sisk

Title

Director of Physician Enterprise

Phone

(443) 422-9941

Specialties & licenses 1

Addresses

Other names 1

• Dr. Stephen Witanowski Doing business as

Medicare fee-for-service enrollment

Enrolled in MD

Enrollment records 1

Part of

Lifebridge Community Phyinc

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

{
    "created_epoch": "1451347200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630022400000",
    "number": "1366807885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5401 OLD COURT RD",
            "city": "RANDALLSTOWN",
            "state": "MD",
            "postal_code": "211335103",
            "telephone_number": "410-701-4439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2700 QUARRY LAKE DR",
            "address_2": "SUITE 280",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212093742",
            "telephone_number": "410-469-5544",
            "fax_number": "410-585-2867"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFEBRIDGE SUBURBAN PHYSICIANS GROUP, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LIFEBRIDGE COMMUNITY PHYSICIANS, LLC",
        "enumeration_date": "2015-12-29",
        "last_updated": "2021-08-27",
        "certification_date": "2021-08-27",
        "status": "A",
        "authorized_official_last_name": "WRIGHT-SISK",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "DIRECTOR OF PHYSICIAN ENTERPRISE",
        "authorized_official_telephone_number": "443-422-9941",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dr. Stephen Witanowski",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Dr. Stephen Witanowski",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Internal Medicine Physician in Baltimore, MD
• Providers in Baltimore, MD by specialty
• Internal Medicine Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2021; 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.