Provider Demographics
NPI:1073580205
Name:LUMINIS HEALTH MEDICAL GROUP, LLC
Entity Type:Organization
Organization Name:LUMINIS HEALTH MEDICAL GROUP, LLC
Other - Org Name:LUMINIS HEALTH MATERNAL AND FETAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER ENROLLMENT COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHAWANA
Authorized Official - Middle Name:
Authorized Official - Last Name:PINKETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-825-8275
Mailing Address - Street 1:2001 MEDICAL PKWY STE 409
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3773
Mailing Address - Country:US
Mailing Address - Phone:443-481-1000
Mailing Address - Fax:443-481-6515
Practice Address - Street 1:185 HARRY S TRUMAN PKWY STE 120
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401
Practice Address - Country:US
Practice Address - Phone:410-224-4442
Practice Address - Fax:410-224-8898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-07
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD297302204Medicaid
MD407175103Medicaid
MD407175108Medicaid
760BCEOtherBCBS
MD407175112Medicaid
K480OtherBCBS
MD407175112Medicaid