Provider Demographics
NPI:1467767806
Name:LUMINIS HEALTH MEDICAL GROUP, LLC
Entity Type:Organization
Organization Name:LUMINIS HEALTH MEDICAL GROUP, LLC
Other - Org Name:ANNE ARUNDEL MEDICAL GROUP-NEUROLOGY SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT BUSINESS DEVELOPMENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-481-6464
Mailing Address - Street 1:PO BOX 412752
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-4017
Mailing Address - Country:US
Mailing Address - Phone:667-204-7000
Mailing Address - Fax:
Practice Address - Street 1:2002 MEDICAL PKWY
Practice Address - Street 2:SUITE 430
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3263
Practice Address - Country:US
Practice Address - Phone:443-481-1940
Practice Address - Fax:443-481-1941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-10
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCX581OtherBCBS
MD407175122Medicaid
MDCF6JASOtherBCBS
129NMedicare PIN
MDDD3213Medicare PIN