Healthcare Provider Details

I. General information

NPI: 1043077159
Provider Name (Legal Business Name): LUMINIS HEALTH MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2024
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2003 MEDICAL PKWY STE 100
ANNAPOLIS MD
21401-3076
US

IV. Provider business mailing address

PO BOX 412752
BOSTON MA
02241-2752
US

V. Phone/Fax

Practice location:
  • Phone: 443-481-3493
  • Fax:
Mailing address:
  • Phone: 443-481-3493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number
License Number State

VIII. Authorized Official

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