Provider Demographics
NPI:1003850769
Name:REZEANU, LUMINITA (MD)
Entity Type:Individual
Prefix:
First Name:LUMINITA
Middle Name:
Last Name:REZEANU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 MEMORIAL MEDICAL CT STE 1
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-4400
Mailing Address - Country:US
Mailing Address - Phone:864-295-3492
Mailing Address - Fax:864-295-4817
Practice Address - Street 1:8 MEMORIAL MEDICAL CT STE 1
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4400
Practice Address - Country:US
Practice Address - Phone:864-295-3492
Practice Address - Fax:864-295-4817
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS19251207ZP0101X
SC38673207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1190918Medicaid
AL122628Medicaid
MSP00449356OtherRR MEDICARE
MS03987533Medicaid
MSP00639241OtherRR MEDICARE
MS03987533Medicaid
MS512I220006Medicare PIN
MS302I228882Medicare PIN
AL122628Medicaid