LIFEBRIDGE COMMUNITY PHYSICIANS, INC (NPI# 1790129054) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790129054 |
| Entity Type | Organization |
| Organization Name | LIFEBRIDGE COMMUNITY PHYSICIANS, INC |
| Other Organization Name | LIFEBRIDGE COMMUNITY PEDIATRICS LLC MAIN STREET PEDIATRICS |
| Practice Address |
515 Fairmount Ave Suite 200 Towson MD 21286-5466 |
| Practice Telephone | 4104941369 |
| Practice Fax Number | 4104942737 |
| Mailing Telephone | 4104941369 |
| Mailing Fax Number | 4104942737 |
| Enumeration Date | 2013-04-17 |
| Last Update Date | 2014-01-02 |
| Authorized Official Name | BRIAN CAWLEY (VICE PRESIDENT) |
| Authorized Official Telephone | 4107014381 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208000000X | Pediatrics | MD | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Lifebridge Community Pediatrics LLC Main Street Pediatrics | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285113704 | Lifebridge Community Physicians, Inc | Internal Medicine | 940 Madison Avenue First Floor, Baltimore, MD 27201 | 2018-08-07 |
| 1144565110 | Lifebridge Community Physicians, Inc | Internal Medicine | 12221 Tullamore Rd, Suite 3, Lutherville Timonium, MD 21093-7816 | 2012-12-03 |
| 1053662858 | Lifebridge Community Physicians, Inc | Internal Medicine | 12221 Tullamore Rd # 3, Lutherville Timonium, MD 21093-7816 | 2012-09-20 |
| 1851873970 | Lifebridge Community Physicians, Inc | Internal Medicine | 711 W. 40th Street, Suite 212a, Baltimore, MD 21211 | 2018-09-05 |
| 1093205841 | Lifebridge Community Physicians, Inc | Orthopaedic Surgery | 10084 Reisterstown Rd, Suite 300a, Owings Mills, MD 21117 | 2018-05-17 |
| 1255702338 | Lifebridge Community Physicians, Inc | Family Medicine | 5401 Old Court Rd, Randallstown, MD 21133-5103 | 2015-10-14 |
| 1437528551 | Lifebridge Community Physicians, Inc | Family Medicine | 6355 Ten Oaks Rd, Suite 202, Clarksville, MD 21029-1185 | 2015-09-18 |
| 1811365828 | Lifebridge Community Physicians, Inc | Orthopaedic Surgery | 2401 W Belvedere Ave, Suite 102-104, Baltimore, MD 21215-5216 | 2015-09-08 |
| 1851768493 | Lifebridge Community Physicians, Inc | Internal Medicine | 12221 Tullamore Rd, Lutherville Timonium, MD 21093-7816 | 2015-08-31 |
| 1760864870 | Lifebridge Community Physicians, Inc | Internal Medicine | 8114 Sandpiper Cir, Suite 206, Nottingham, MD 21236-4934 | 2015-06-25 |
| Street Address |
515 FAIRMOUNT AVE SUITE 200 |
| City | TOWSON |
| State | MD |
| Zip Code | 21286-5466 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013910454 | David S. Berliner | Internal Medicine | 515 Fairmount Ave, Ste 400, Towson, MD 21286-5466 | 2005-05-31 |
| 1598253403 | Courtney Alyse Mcguire | Occupational Therapy Assistant | 515 Fairmount Ave, Towson, MD 21286-5466 | 2018-04-25 |
| 1699280511 | Genesis Eldercare Physician Services LLC | Internal Medicine | 515 Fairmount Ave, Towson, MD 21286 | 2017-12-14 |
| 1497296271 | Candice Korolevich | Nurse Practitioner | 515 Fairmount Ave, Towson, MD 21286 | 2017-03-14 |
| 1124572763 | Gps Physician Group of Texas Pllc | Internal Medicine | 515 Fairmount Ave, Towson, MD 21286-5466 | 2016-08-11 |
| 1659737898 | Genesis Eldercare Physician Services LLC | Internal Medicine | 515 Fairmount Ave, Towson, MD 21286-5466 | 2016-01-04 |
| 1184095267 | Genesis Eldercare Physician Services LLC | Internal Medicine | 515 Fairmount Ave, Towson, MD 21286-5466 | 2015-10-14 |
| 1104297852 | Genesis Eldercare Physician Services LLC | Internal Medicine | 515 Fairmount Ave, Towson, MD 21286-5466 | 2015-10-07 |
| 1982074001 | Clinical Associates P A | Clinic/Center | 515 Fairmount Ave, Ste 100a, Towson, MD 21286-5466 | 2015-10-01 |
| 1417344284 | Genesis Staffing Services, LLC | Community/Behavioral Health | 515 Fairmount Ave, 8th Floor, Towson, MD 21286-5466 | 2015-04-20 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750989042 | Osereme Nora Agboifo | Nurse Practitioner | 200 Ejoppa Rd Suite 106, Townson, MD 21286 | 2020-10-09 |
| 1801434543 | Bh Brightview Towson Opco, LLC | Alzheimer Center (Dementia Center) | 20 E. Burke Avenue, Baltimore, MD 21286 | 2019-12-12 |
| 1417598897 | Tyler Tuggle | Home Health Aide | 8601 Lasalle Rd., Suite 100, Towson, MD 21286 | 2019-10-07 |
| 1285289629 | Center for Creative Values Inc | Community/Behavioral Health | 515 E. Joppa Rd Suite 100 & 104, Towson, MD 21286 | 2019-08-02 |
| 1275195117 | Watermark Health Services | Chore Provider | 1045 Taylor Avenue Suite 106e, Towson, MD 21286 | 2019-07-01 |
| 1609337021 | Tyler James Howard | Psychologist | 8600 Lasalle Road Carroll Building, Suite 212, Towson, MD 21286 | 2019-03-28 |
| 1477019578 | Ruth Marie Collins | Counselor | 8501 Lasalle Rd., Suite 115, Towson, MD 21286 | 2019-02-13 |
| 1396200671 | Christian Dorry | Behavior Technician | Epic Developmental Services, 1026 Cromwell Bridge Rd, Towson, MD 21286 | 2019-01-31 |
| 1831667799 | Casey O'sullivan | Counselor | 1220 E. Joppa Rd., Bldg B, Ste 332, Towson, MD 21286 | 2018-11-08 |
| 1649763053 | Rosemary O Okpulor | Nurse Practitioner | 8510 Lasalle Rd, Suite 310, Towson, MD 21286 | 2018-06-11 |
| Find all providers in zip 21286 | ||||
| Taxonomy Code | 208000000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| 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. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104250570 | Charles Patrick Chaulk | Pediatrics | 622 Valley Ln, Towson, MD 21286-7311 | 2013-08-21 |
| 1235339508 | Justine O Rhue | Pediatrics | 8600 La Salle Rd Ste 105, Towson, MD 21286-2008 | 2007-07-24 |
| 1528014974 | Mahboubeh Dadash Zadeh | Pediatrics | 1109 Green Acre Road, Towson, MD 21286 | 2006-05-26 |
| 1790754612 | Scott D Krugman | Pediatrics | 8000b Loch Raven Blvd, Towson, MD 21286-8337 | 2006-03-14 |
| 1164490033 | Rose Mary Mulaikal | Pediatrics | 849 Fairmont Avenue, Suite 100a, Towson, MD 21286-2600 | 2006-03-08 |
| 1093782153 | Jeffries L.g. Bucci | Pediatrics | 7600 Osler Drive, Suite 310, Towson, MD 21204-7702 | 2006-03-07 |
| 1154955862 | Nardine Assaad, Md, LLC | Pediatrics | 120 Sister Pierre Dr Ste 305, Towson, MD 21204-7526 | 2020-03-03 |
| 1629495528 | Lifebridge Community Pediatrics, LLC | Pediatrics | 849 Fairmont Avenue, Suite 100a, Towson, MD 21286-2600 | 2014-03-28 |
| 1861830374 | Lifebridge Community Physicians, Inc | Pediatrics | 515 Fairmount Ave, Suite 200, Towson, MD 21286-5466 | 2013-06-06 |
| 1619219797 | Kathryn Chenault | Pediatrics | 8600 Lasalle Road, Suite 105, Towson, MD 21286 | 2013-03-26 |
| Find all providers in TOWSON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.