Healthcare Provider Details

I. General information

NPI: 1831341981
Provider Name (Legal Business Name): LUMINIS HEALTH MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 05/24/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2003 MEDICAL PKWY SUITE 301
ANNAPOLIS MD
21401-7992
US

IV. Provider business mailing address

PO BOX 62312
BALTIMORE MD
21264-0001
US

V. Phone/Fax

Practice location:
  • Phone: 443-481-1000
  • Fax: 443-481-6515
Mailing address:
  • Phone: 443-481-6476
  • Fax: 443-481-6515

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: PETER ODENWALD
Title or Position: VICE PRESIDENT
Credential:
Phone: 443-481-6415