Provider Demographics
NPI:1548595978
Name:LUMINIS HEALTH MEDICAL GROUP, LLC
Entity type:Organization
Organization Name:LUMINIS HEALTH MEDICAL GROUP, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AO
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAPATTONI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-481-5136
Mailing Address - Street 1:PO BOX 412752
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-2752
Mailing Address - Country:US
Mailing Address - Phone:443-481-6571
Mailing Address - Fax:443-481-6515
Practice Address - Street 1:2003 MEDICAL PKWY STE 210
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3093
Practice Address - Country:US
Practice Address - Phone:301-552-8863
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LUMINIS HEALTH MEDICAL GROUP, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-02
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD407175112Medicaid
MD407175112Medicaid