Healthcare Provider Details

I. General information

NPI: 1063837490
Provider Name (Legal Business Name): LUMINIS HEALTH MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2014
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8109 RITCHIE HWY SUITE 100
PASADENA MD
21122-6917
US

IV. Provider business mailing address

201 DEFENSE HWY
ANNAPOLIS MD
21401-8943
US

V. Phone/Fax

Practice location:
  • Phone: 443-270-8600
  • Fax: 443-270-8990
Mailing address:
  • Phone: 443-481-1000
  • Fax: 443-481-6515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD27388
License Number StateMD

VIII. Authorized Official

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