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General NPI Number Information
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NPI Number | 1790262244
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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 | 07/26/2018
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Last Update Date | 05/24/2021
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Provider Practice Location Address
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Address Line | 1106 ANNAPOLIS RD STE 220
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City | ODENTON
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State | MD
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Zip | 21113-1740
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Country | US
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Telephone | 443-481-1199
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Fax | 443-481-1495
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Provider Business Mailing Address
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Address Line | 201 DEFENSE HWY STE 100
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City | ANNAPOLIS
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State | MD
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Zip | 21401-8902
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Country | US
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Telephone | 443-481-5310
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Fax | 443-481-6515
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Authorized Official
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Title or Position | REIMBURSEMENT ADMINISTRATORS
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Name | PETER ODENWALD
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Credential |
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Telephone | 443-481-6415
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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 |
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