Organization · NPI-2

Luminis Health Medical Group, LLC

Family Medicine · Edgewater, MD

NPI number1699742874
StatusActive
Last updated in NPPESNov 5, 2024

Details

NPI
1699742874
Entity type
Organization (NPI-2)
Legal business name
Luminis Health Medical Group, LLC
Organization subpart
Yes
Enumeration date
Mar 7, 2006
Certification date
Nov 5, 2024
Last updated
Nov 5, 2024

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Q00000X Family Medicine––Yes

Other names

  • South River Family Medicine (Doing Business As)

Practice location

3169 Braverton St
Suite 201
Edgewater, MD 21037-2679

Phone 410-956-4911 · Fax 410-956-4935

Mailing address

2000 Medical Pkwy Ste 409
Annapolis, MD 21401-3746

Phone 443-481-5136 · Fax 443-481-6515

Authorized official

Melissa Rapattoni
Ao
4434815136

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