Organization · Type 2 NPI

Lifebridge Suburban Physician Group II LLC

Pediatric Adolescent Medicine Physician · Randallstown, MD

NPI number 1194170027 Active

Practice location

5400 Old Court Rd Ste 300B
Randallstown, MD 21133-5100

Call (410) 521-7337 Map

Fax (410) 521-7377

Mailing address

3527 N Rolling Rd, # 1
Baltimore, MD 21244-2223

Other practice locations

3527 N Rolling Rd, # 1, Baltimore, MD 21244-2223 · (410) 521-7337

Specialties and licenses

Taxonomy	Code	License
Pediatric Adolescent Medicine Physician Primary	2080A0000X	None listed

Pediatric Adolescent Medicine Physician: A pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs.

5 other providers at this address

NPI record

NPI: 1194170027
Entity type: Organization (Type 2)
Issued: Apr 28, 2016
Last updated: Aug 31, 2021
Status: Active
Subpart: Yes of Lifebridge Community Physicians, Inc.

Other names

<unavail>
Dr. Jacalyn Blackwell-White · doing business as
Dr. Jacalyn Blackwell-White · doing business as

Authorized official

Mary Wright-Sisk
Director
(443) 422-9941

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1194170027

Lifebridge Suburban Physician Group II LLC's National Provider Identifier is 1194170027, issued on Apr 28, 2016. The primary taxonomy on file is Pediatric Adolescent Medicine Physician (2080A0000X), and the practice location is in Randallstown, MD. The record was last updated on Aug 31, 2021.