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LIFEBRIDGE SUBURBAN PHYSICIAN GROUP II LLC
NPI 1033900352
Pediatrics in Glen Burnie, MD

Active since May 15, 2025CLIA 21D2128233 · Waiver
1405 MADISON PARK DR, GLEN BURNIE, MD 21061(410) 308-7865(410) 308-7818 Get Directions Write a Review

NPPES record last updated: May 15, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Lifebridge Suburban Physician Group Ii Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LIFEBRIDGE SUBURBAN PHYSICIAN GROUP II LLC (NPI 1033900352) is a healthcare organization registered as a pediatrics in Glen Burnie, Maryland and active in the NPI registry since May 2025. The organization holds a CLIA Waiver certificate valid through October 24, 2027 and lists Mary Rebecca Wright-sisk, Director, as its authorized official.

NPPES Registry Identity

NPI1033900352
Entity TypeOrganization
Primary Taxonomy208000000X
Legal Business NameLIFEBRIDGE SUBURBAN PHYSICIAN GROUP II LLC
Location Address1405 MADISON PARK DRGlen Burnie, MD 21061-5627
Mailing Address1405 Madison Park DrGlen Burnie, MD 21061-5627 · (410) 308-7865 · Fax (410) 308-7818
Phone(410) 308-7865
Fax(410) 308-7818
Organization SubpartNo
Authorized OfficialMary Rebecca Wright-siskDirector · (443) 422-9941
Enumeration DateMay 15, 2025
NPPES CertifiedMay 15, 2025
✔ NPI 1033900352 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians
Taxonomy Code208000000X
Definition
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.
1405 MADISON PARK DR, Glen Burnie, MD 21061
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Other Names 1

Other NameDr. Gaurav Kumar At Madison Park

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 21D2128233

Lifebridge Suburban Phys Grp LLC Dba Gaurav Kumar · Lutherville, MD
Active · expires Oct 24, 2027
CLIA Number21D2128233
Laboratory TypePhysician Office
Certificate Effective DateOctober 25, 2025
Certificate Expiration DateOctober 24, 2027
Laboratory DirectorGaurav Kumar
Laboratory Phone(410) 308-7865
Laboratory LocationLifebridge Suburban Phys Grp LLC Dba Gaurav Kumar12221 Tullamore Rd, Lutherville, MD 21093
CLIA data matches this NPI record on: Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 7

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DAWN M GRETZ D P M P A
Durable Medical Equipment & Medical Supplies (Customized Equipment)
1405 MADISON PARK DR
GLEN BURNIE, MD 21061
Anne Arundel County (410) 761-1666
DR. BRYAN PHILIP KEEGAN D.M.D.
Dentist (Oral and Maxillofacial Surgery)
1405 MADISON PARK DR, SUITE 1
GLEN BURNIE, MD 21061
Anne Arundel County (410) 761-7766
NAOMI N SHAIKH MD
Pediatrics
1405 MADISON PARK DR, SUITE 1
GLEN BURNIE, MD 21061
Anne Arundel County (410) 582-9434
MARCELLUS R. CEPHAS, MD LLC
Psychologist (Prescribing (Medical))
1405 MADISON PARK DR, SUITE 1B
GLEN BURNIE, MD 21061
Anne Arundel County (410) 487-6302
DAWN M. GRETZ D P M P A
Podiatrist (Foot & Ankle Surgery)
1405 MADISON PARK DR
GLEN BURNIE, MD 21061
Anne Arundel County (410) 761-1666
LIFEBRIDGE SUBURBAN PHYSICIAN GROUP II LLC
Pediatrics
1405 MADISON PARK DR, SUITE 1
GLEN BURNIE, MD 21061
Anne Arundel County (410) 582-9434
DR. DAWN MARIE GRETZ DPM
Podiatrist (Foot & Ankle Surgery)
1405 MADISON PARK DR
GLEN BURNIE, MD 21061
Anne Arundel County (410) 761-1666

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Lifebridge Suburban Physician Group II LLC's NPI number?

The NPI number for Lifebridge Suburban Physician Group II LLC is 1033900352. It was assigned to this organization in the NPPES registry on May 15, 2025. The provider is also known as Dr. Gaurav Kumar at Madison Park.

Where is Lifebridge Suburban Physician Group II LLC located?

Lifebridge Suburban Physician Group II LLC is located at 1405 Madison Park Dr, Glen Burnie, MD 21061. The listed phone number is (410) 308-7865.

What is Lifebridge Suburban Physician Group II LLC's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

Does Lifebridge Suburban Physician Group II LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 21D2128233) is associated with this NPI, valid through October 24, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Lifebridge Suburban Physician Group II LLC was last updated on May 15, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.