1013319011 NPI number — LIFEBRIDGE CARDIOLOGY OF PARKVILLE, LLC

Table of content: (NPI 1013319011)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013319011 NPI number — LIFEBRIDGE CARDIOLOGY OF PARKVILLE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIFEBRIDGE CARDIOLOGY OF PARKVILLE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013319011
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/31/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5415 OLD COURT RD
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
RANDALLSTOWN
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21133-5170
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-308-7855
Provider Business Mailing Address Fax Number:
410-308-7856

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5415 OLD COURT RD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
RANDALLSTOWN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21133-5170
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-308-7855
Provider Business Practice Location Address Fax Number:
410-308-7856
Provider Enumeration Date:
09/22/2014

Additional Information

Authorized Official

Authorized Official Last Name:
WRIGHT-SISK
Authorized Official First Name:
MARY
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
443-422-9941

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com