Healthcare Provider Details

I. General information

NPI: 1538793088
Provider Name (Legal Business Name): LUMINIS HEALTH MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2020
Last Update Date: 05/24/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2970 BELCREST CENTER DR STE 301
HYATTSVILLE MD
20782-1987
US

IV. Provider business mailing address

2001 MEDICAL PKWY
ANNAPOLIS MD
21401-3773
US

V. Phone/Fax

Practice location:
  • Phone: 301-599-9500
  • Fax:
Mailing address:
  • Phone: 443-481-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MARISSA ROSANIO
Title or Position: SENIOR MANAGER
Credential:
Phone: 443-481-4150