Life Line Corporation -4 LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

LIFE LINE CORPORATION -4 LLC

Practice address

2111 Hanover Pike
Hampstead, MD 21074-1319

Phone

(443) 255-3951

NPI assigned

May 2, 2025

Last updated

May 2, 2025By 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

Kamal Gordhanbhai Bangoria, MDNPI 1417168675

Title

Owner

Phone

(410) 848-2566

Specialties & licenses 1

Addresses

Practitioners 3

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.

• Kamal Gordhanbhai Bangoria, M.D.

  • Internal Medicine Physician
  • Westminster, MD
  • NPI 1417168675
  NPD Authorized official
• Jillian Dickenski, CRNP

  • Family Nurse Practitioner
  • Columbia, MD
  • NPI 1700580438
  NPD (past)
• Andrea L Hrehocik, PAC

  • Physician Assistant
  • Hampstead, MD
  • NPI 1659346724
  NPD (past)

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

{
    "created_epoch": "1746144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1746144000000",
    "number": "1942099247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1798 ODEN WAY",
            "city": "ELDERSBURG",
            "state": "MD",
            "postal_code": "217847095",
            "telephone_number": "443-255-3951"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2111 HANOVER PIKE",
            "city": "HAMPSTEAD",
            "state": "MD",
            "postal_code": "210741319",
            "telephone_number": "443-255-3951"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE LINE CORPORATION -4 LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-05-02",
        "last_updated": "2025-05-02",
        "certification_date": "2025-05-02",
        "status": "A",
        "authorized_official_last_name": "BANGORIA",
        "authorized_official_first_name": "KAMAL",
        "authorized_official_middle_name": "GORDHANBHAI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "410-848-2566",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Christina Lantz, CRNP
• Erica Letow, PHARM.D.
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• Lifebridge Sports Medicine & Rehabilitation, LLC (Lifebridge Health Physical Therapy in collaboration with NovaCare Reha)
• Little Hands to Play and Grow Therapy, LLC
• Manchester Medical Center, LLC

• Internal Medicine Physician in Hampstead, MD
• Providers in Hampstead, 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 May 2, 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.