| Lifebridge Multi-specialty, LLC | |
|
41 Magna Way Suite 100 Westminster MD 21157-3073 | |
| (410) 751-6684 | |
| (410) 751-2371 |
| Full Name | Lifebridge Multi-specialty, LLC |
|---|---|
| Speciality | Family Medicine |
| Location | 41 Magna Way, Westminster, Maryland |
| Authorized Official Name and Position | Mary R Wright-sisk (DIRECTOR) |
| Authorized Official Contact | 4107014439 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lifebridge Multi-specialty, LLC 41 Magna Way Suite 100 Westminster MD 21157-3073 Ph: (410) 751-6684 | Lifebridge Multi-specialty, LLC 41 Magna Way Suite 100 Westminster MD 21157-3073 Ph: (410) 751-6684 |
| NPI Number | 1972978625 |
|---|---|
| Provider Enumeration Date | 12/07/2015 |
| Last Update Date | 12/07/2015 |
| Medicare PECOS PAC ID | 1153625660 |
|---|---|
| Medicare Enrollment ID | O20160203001931 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972978625 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Primary |
| Provider Name | Renee J Orlando Hart |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699730010 PECOS PAC ID: 4587675517 Enrollment ID: I20060505000368 |
| Provider Name | Kimberly Deltuva |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1972568913 PECOS PAC ID: 8628053725 Enrollment ID: I20071004000527 |
| Provider Name | Peggy Klucina |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1710262886 PECOS PAC ID: 8921272741 Enrollment ID: I20111114000121 |
| Provider Name | Dennis N Vinias |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1912275926 PECOS PAC ID: 7416195300 Enrollment ID: I20150318001808 |
| Provider Name | Gabrielle Helwig |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376316935 PECOS PAC ID: 0547611915 Enrollment ID: I20240110001660 |
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