Healthcare Provider Details

I. General information

NPI: 1477950970
Provider Name (Legal Business Name): LUMINIS HEALTH MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2014
Last Update Date: 05/24/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 MEDICAL PKWY DONNER PAVILION
ANNAPOLIS MD
21401-3280
US

IV. Provider business mailing address

PO BOX 12622
BELFAST ME
04915-4017
US

V. Phone/Fax

Practice location:
  • Phone: 443-481-1000
  • Fax: 443-481-6515
Mailing address:
  • Phone: 443-481-5049
  • Fax: 443-481-6515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. STEPHEN L CLARKE
Title or Position: VICE PRESIDENT
Credential:
Phone: 443-481-6558