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NPI Code Detail

MEDICARE: LUMINIS HEALTH MEDICAL GROUP, LLC

MEDICARE: LUMINIS HEALTH MEDICAL GROUP, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332B00000XDurable Medical Equipment & Medical Supplies

General Provider Information

NPI Number : 1285373258
Entity Type Code : Organization
Provider Name (Legal Business Name) : LUMINIS HEALTH MEDICAL GROUP, LLC
Provider Business Mailing Address
First Line : 2000 MEDICAL PKWY STE 101
Second Line :
City : ANNAPOLIS
State : MD
Zip : 21401-3743
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2000 MEDICAL PKWY STE 101
Second Line :
City : ANNAPOLIS
State : MD
Zip : 21401-3743
Country : US
Telephone Number : 410-268-8862
Fax Number :
Authorized Official
Title or Position : DIRECTOR
Name : PETER ODENWALD
Credential :
Telephone Number : 443-481-6415
Provider Enumeration Date : 05/31/2022
Last Update Date : 05/04/2026

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Directions to “LUMINIS HEALTH MEDICAL GROUP, LLC ” Practice Location

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