# LUMINIS HEALTH MEDICAL GROUP, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Eastern Shore Primary Care
- **Organization subpart:** No

## Provider details

- **NPI number:** 1831463298
- **Authorized official:** PETER ODENWALD (VICE PRESIDENT)
- **Authorized official phone:** (443) 481-6415

## Contact information

- **Practice address:** 1630 MAIN ST, CHESTER, MD 21619-2791
- **Practice address phone:** (410) 643-4524
- **Practice address fax:** (410) 643-4523
- **Mailing address:** PO BOX 12622, BELFAST, ME 04915-4017
- **Mailing address phone:** (443) 481-6576
- **Mailing address fax:** (443) 481-6515

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/02/2012
- **Last updated:** 05/24/2021