Basic Information
| Provider Information | |||||||||
| NPI: | 1053944728 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LUMINIS HEALTH MEDICAL GROUP, LLC | ||||||||
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| OtherOrganizationName: | DCMC SURGICAL APP | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2001 MEDICAL PKWY OFC | ||||||||
| Address2: | |||||||||
| City: | ANNAPOLIS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 214013773 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4434811000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2970 BELCREST CENTER DR STE 301 | ||||||||
| Address2: | |||||||||
| City: | HYATTSVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207821987 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3018500486 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2020 | ||||||||
| LastUpdateDate: | 05/21/2021 | ||||||||
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| AuthorizedOfficialLastName: | ROSANIO | ||||||||
| AuthorizedOfficialFirstName: | MARISSA | ||||||||
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| AuthorizedOfficialTitleorPosition: | SENIOR MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4434814150 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 05/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 235Z00000X | N | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 261QP2000X | N | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy | 282N00000X | N | Hospitals | General Acute Care Hospital | 207X00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.