Organization Name: | LIFEBRIDGE GYNECOLOGY OF PIKESVILLE, LLC |
NPI Number: | 1134529779 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MARY WRIGHT-SISK (DIRECTOR) |
Mailing Address: | 4000 Old Court Rd Suite 301 Pikesville |
State: | MD US |
Postal Code: | 212082800 |
Phone Number: | 4106530000 |
Fax Number: | 4106535531 |
NPI Enumeration Date: | 09/02/2014 |
NPI Last Update Date: | 09/02/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 207VG0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MD |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Obstetrics & Gynecology |
Taxonomy Specialization: | Gynecology |
Taxonomy Definition: |