Healthcare Provider Details

I. General information

NPI: 1275485948
Provider Name (Legal Business Name): LUMIN HEALTH PG MARYLAND, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2026
Last Update Date: 02/13/2026
Certification Date: 02/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4825 BETHESDA AVE FL 2
BETHESDA MD
20814-5245
US

IV. Provider business mailing address

10 LANGLEY RD STE 200
NEWTON MA
02459-1972
US

V. Phone/Fax

Practice location:
  • Phone: 617-863-8810
  • Fax:
Mailing address:
  • Phone: 617-863-8810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: BENJAMIN YUDKOFF
Title or Position: OWNER
Credential: MD, MA
Phone: 617-863-8810