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
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1861223604
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUMINIS HEALTH MEDICAL GROUP, LLC

Provider Business Mailing Address
First Line	:	2000 MEDICAL PKWY STE 409
Second Line	:
City	:	ANNAPOLIS
State	:	MD
Zip	:	21401-3746
Country	:	US
Telephone Number	:	443-481-5136
Fax Number	:	443-481-4151

Provider Business Practice Location Address
First Line	:	2191 DEFENSE HWY STE 201
Second Line	:
City	:	CROFTON
State	:	MD
Zip	:	21114-2469
Country	:	US
Telephone Number	:	443-481-1000
Fax Number	:

Authorized Official
Title or Position	:	AO
Name	:	MELISSA RAPATTONI
Credential	:
Telephone Number	:	443-481-5136

Provider Enumeration Date	:	08/13/2024
Last Update Date	:	08/13/2024

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