Lifebridge Community Physicians, Inc

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

LIFEBRIDGE COMMUNITY PHYSICIANS, INC

Doing business as

Main Street Pediatrics

Practice address

515 Fairmount Ave
Suite 200
Towson, MD 21286-5466

Phone

(410) 494-1369

Fax

(410) 494-2737

NPI assigned

Jun 6, 2013

Last updated

Aug 27, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mary Wright-Sisk

Title

Director

Phone

(443) 422-9941

Specialties & licenses 1

Addresses

Other names 1

• Main Street Pediatrics Doing business as

Medicare fee-for-service enrollment

Enrolled in MD

Enrollment records 1

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

{
    "created_epoch": "1370476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630022400000",
    "number": "1861830374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "515 FAIRMOUNT AVE",
            "address_2": "SUITE 200",
            "city": "TOWSON",
            "state": "MD",
            "postal_code": "212865466",
            "telephone_number": "410-494-1369",
            "fax_number": "410-494-2737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 FAIRMOUNT AVE",
            "address_2": "SUITE 200",
            "city": "TOWSON",
            "state": "MD",
            "postal_code": "212865466",
            "telephone_number": "410-494-1369",
            "fax_number": "410-494-2737"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFEBRIDGE COMMUNITY PHYSICIANS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-06",
        "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",
        "authorized_official_telephone_number": "443-422-9941"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MD",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Main Street Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Main Street Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lifebridge Community Physicians Inc
• Lifebridge Community Physicians Inc
• Lifebridge Community Physicians Inc
• Lifebridge Community Physicians, Inc (Lifebridge Community Pediatrics LLC Main Street Pediatrics)
• Lifebridge Community Physicians, Inc
• Lifebridge Community Physicians, Inc. (Dr. Anisa Mirza)
• Lifebridge Investments, Inc (LifeBridge Community Practices, LLC d/b/a Clinical Associates ASC)
• Lifebridge Investments, Inc. and Subsidiaries (LifeBridge Community Practices, LLC Clinical Associates Sleep Center)
• Lifebridge Multi-Specialty. LLC (Clinical Associates)
• Lifebridge Orthopedic Specialists, LLC

• Pediatrics Physician in Towson, MD
• Providers in Towson, MD by specialty
• Pediatrics 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.