NPIMap

Organization Active NPI

Lifebridge Community Physicians Inc

  • Internal Medicine Physician
  • Baltimore, MD
National Provider Identifier
1417757279
Registry record updated Mar 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
LIFEBRIDGE COMMUNITY PHYSICIANS INC
Practice address
711 W 40TH St Ste 212a
Baltimore, MD 21211-2108
Phone
(410) 601-0071
Fax
(410) 601-0290
NPI assigned
Mar 19, 2025
Last updated
Mar 19, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 19, 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
Internal Medicine Physician 207R00000X Primary

Addresses

Primary practice location

711 W 40TH St Ste 212a
Baltimore, MD 21211-2108

Mailing address

711 W 40TH St Ste 212a
Baltimore, MD 21211-2108
Phone (410) 601-0071

Other names 1

  • LifeBridge Health Primary Care of Baltimore Other name

National Provider Directory

National Provider Directory
Tax ID family
DRS Gouel and Blotny148 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1742342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742342400000",
    "number": "1417757279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 W 40TH ST STE 212A",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212112108",
            "telephone_number": "410-601-0071",
            "fax_number": "410-601-0290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 W 40TH ST STE 212A",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212112108",
            "telephone_number": "410-601-0071",
            "fax_number": "410-601-0290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFEBRIDGE COMMUNITY PHYSICIANS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-03-19",
        "last_updated": "2025-03-19",
        "certification_date": "2025-03-19",
        "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": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LifeBridge Health Primary Care of Baltimore",
            "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 19, 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.