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General NPI Number Information
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NPI Number | 1003392382
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Entity Type | Organization
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Legal Business Name | LUMINIS HEALTH MEDICAL GROUP, LLC
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Dates
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Enumeration Date | 07/19/2018
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Last Update Date | 05/21/2021
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Provider Practice Location Address
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Address Line | 100 BRAMBLE ST STE E&F
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City | CAMBRIDGE
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State | MD
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Zip | 21613-2471
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Country | US
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Telephone | 410-820-0038
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Fax | 410-820-0039
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Provider Business Mailing Address
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Address Line | 201 DEFENSE HWY STE 150
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City | ANNAPOLIS
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State | MD
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Zip | 21401-8953
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Country | US
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Telephone | 144-348-1531
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Fax | 443-481-6515
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Authorized Official
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Title or Position | REIMBURSEMENT ADMINISTRATOR
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Name | JEANNETTE WOOD
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Credential |
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Telephone | 443-481-6521
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 176B00000X
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Taxonomy Name | Midwife
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License Number |
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License Number State | MD
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