Organization
LUMINIS HEALTH MEDICAL GROUP, LLC
Active
Other names
AAMC Community Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN L CLARKE (VICE PRESIDENT- PHYSICIAN SERVICES)
(443) 481-6464
Entity
Organization
Contact information
Practice address
1419 FOREST DR, ANNAPOLIS, MD 21403-1482
(410) 990-0050
(410) 990-0336
Mailing address
PO BOX 62551, BALTIMORE, MD 21264-2551
(443) 481-6572
(443) 481-6515
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
407175128
—
MD
Enumeration date
09/27/2010
Last updated
05/24/2021
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