Healthcare Provider Details

I. General information

NPI: 1912324831
Provider Name (Legal Business Name): LUMINIS HEALTH MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2014
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 MEDICAL PKWY FL 1
ANNAPOLIS MD
21401-3795
US

IV. Provider business mailing address

2002 MEDICAL PKWY STE 409
ANNAPOLIS MD
21401-3046
US

V. Phone/Fax

Practice location:
  • Phone: 443-481-5800
  • Fax: 443-481-5808
Mailing address:
  • Phone: 443-481-6573
  • Fax: 443-481-6515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number
License Number State

VIII. Authorized Official

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