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LIFEBRIDGE COMMUNITY PEDIATRICS LLC NPI 1629495528


NPI Information

NPI: 1629495528
Provider Name: LIFEBRIDGE COMMUNITY PEDIATRICS, LLC

Doing Business As: MAIN STREET PEDIATRICS

Classification: Pediatrics - 208000000X
Entity Type: Organization

CLIA Number: 21D0684816

Address:
849 FAIRMONT AVENUE
SUITE 100A
TOWSON, MD
ZIP 21286
Phone: (410) 494-1369
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LIFEBRIDGE COMMUNITY PEDIATRICS, LLC is a pediatrics in Towson, MD. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. LIFEBRIDGE COMMUNITY PEDIATRICS, LLC NPI is 1629495528. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Main Street Pediatrics.

The provider's business location address is:

849 FAIRMONT AVENUE
SUITE 100A
TOWSON, MD
ZIP 21286-600
Phone: (410) 494-1369
Fax: (410) 494-2737

The provider's authorized official is Mary Wright-sisk .
The authorized official title is Director and has the following contact phone number (410) 521-2200.

The CLIA number assigned to this NPI record is 21D0684816 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/28/2014 and was last updated on 3/16/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1208000000XPediatricsMARYLANDYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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