Healthcare Provider Details

I. General information

NPI: 1457868721
Provider Name (Legal Business Name): LUMINIS HEALTH MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2018
Last Update Date: 05/24/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

183 HARRY S TRUMAN PKWY STE 120
ANNAPOLIS MD
21401-7579
US

IV. Provider business mailing address

201 DEFENSE HWY STE 150
ANNAPOLIS MD
21401-8953
US

V. Phone/Fax

Practice location:
  • Phone: 410-573-5300
  • Fax: 410-573-5305
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: JEANNETTE WOOD
Title or Position: REIMBURSEMENT ADMINISTRATOR
Credential:
Phone: 443-481-6521