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General NPI Number Information
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NPI Number | 1700113776
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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 | 11/11/2009
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Last Update Date | 10/15/2024
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Provider Practice Location Address
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Address Line | 1630 MAIN ST SUITE 213
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City | CHESTER
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State | MD
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Zip | 21619-2791
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Country | US
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Telephone | 410-266-9966
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Fax | 410-266-6819
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Provider Business Mailing Address
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Address Line | 2000 MEDICAL PKWY STE 409
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City | ANNAPOLIS
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State | MD
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Zip | 21401-3746
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Country | US
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Telephone | 443-481-6538
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Fax | 443-481-6515
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Authorized Official
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Title or Position | AO
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Name | MELISSA RAPATTONI
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Credential |
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Telephone | 443-481-5136
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086X0206X
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Taxonomy Name | Surgical Oncology Physician
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License Number |
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License Number State |
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