Healthcare Provider Details

I. General information

NPI: 1356862528
Provider Name (Legal Business Name): LUMINIS HEALTH MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2017
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 MEDICAL PKWY STE 304
ANNAPOLIS MD
21401-3745
US

IV. Provider business mailing address

2001 MEDICAL PKWY STE 409
ANNAPOLIS MD
21401-3773
US

V. Phone/Fax

Practice location:
  • Phone: 410-573-9530
  • Fax: 410-573-9569
Mailing address:
  • Phone: 443-481-1000
  • Fax: 443-481-4151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: MELISSA RAPATTONI
Title or Position: AO
Credential:
Phone: 443-481-5136