Healthcare Provider Details

I. General information

NPI: 1952564528
Provider Name (Legal Business Name): LUMINIS HEALTH MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 COURSEVALL DR STE 101
CENTREVILLE MD
21617-2805
US

IV. Provider business mailing address

2001 MEDICAL PKWY STE 409
ANNAPOLIS MD
21401-3773
US

V. Phone/Fax

Practice location:
  • Phone: 410-758-3303
  • Fax: 410-758-3310
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD35048
License Number StateMD

VIII. Authorized Official

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