NPIMap

Organization Active NPI

Lifebridge Community Gastroenterology, LLC

  • Gastroenterology Physician
  • Baltimore, MD
National Provider Identifier
1376345140
Registry record updated Mar 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
Legal business name
LIFEBRIDGE COMMUNITY GASTROENTEROLOGY, LLC
Practice address
3001 S Hanover St Ste 300
Baltimore, MD 21225-1233
Phone
(410) 602-7782
Fax
(410) 602-9344
NPI assigned
Mar 25, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 25, 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
Gastroenterology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RG0100X Primary

Addresses

Primary practice location

3001 S Hanover St Ste 300
Baltimore, MD 21225-1233

Mailing address

3001 S Hanover St Ste 300
Baltimore, MD 21225-1233
Phone (410) 602-7782

Other names 1

  • LifeBridge Community Gastroenterology LLC at Hanover Other name

National Provider Directory

National Provider Directory
Tax ID family
Lifebridge Community Gastroenterology LLC13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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": "1742860800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742860800000",
    "number": "1376345140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3001 S HANOVER ST STE 300",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212251233",
            "telephone_number": "410-602-7782",
            "fax_number": "410-602-9344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3001 S HANOVER ST STE 300",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212251233",
            "telephone_number": "410-602-7782",
            "fax_number": "410-602-9344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFEBRIDGE COMMUNITY GASTROENTEROLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-03-25",
        "last_updated": "2025-03-25",
        "certification_date": "2025-03-25",
        "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": "207RG0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LifeBridge Community Gastroenterology LLC at Hanover",
            "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 Mar 25, 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.