Organization
LUMINIS HEALTH MEDICAL GROUP, LLC
Active
Other names
Ulmer Family Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN CLARKE (VICE PRESIDENT)
(443) 481-6464
Entity
Organization
Contact information
Practice address
2000 MEDICAL PKWY, SUITE 605, ANNAPOLIS, MD 21401-3742
(410) 266-5667
(410) 266-9332
Mailing address
PO BOX 12622, BELFAST, ME 04915-4017
(443) 481-6460
(443) 481-6515
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
407175134
—
MD
01
—
Y910
BCBS
—
Enumeration date
01/27/2012
Last updated
05/24/2021
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