Healthcare Provider Details

I. General information

NPI: 1649248485
Provider Name (Legal Business Name): LUMINIS HEALTH MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 11/05/2024
Certification Date: 10/31/2024
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 412752
BOSTON MA
02241-2175
US

V. Phone/Fax

Practice location:
  • Phone: 443-481-3717
  • Fax: 443-481-3720
Mailing address:
  • Phone: 443-481-3356
  • Fax: 443-481-6515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

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