Organization
LUMINIS HEALTH MEDICAL GROUP, LLC
Active
Other names
Chester River OB/GYN
Organization subpart
No
Provider details
NPI number
Authorized official
PETER ODENWALD (VICE PRESIDENT)
(443) 481-6415
Entity
Organization
Contact information
Practice address
521 WASHINGTON AVE, CHESTERTOWN, MD 21620-1217
(410) 810-0767
(410) 630-1677
Mailing address
PO BOX 12622, BELFAST, ME 04915-4017
(443) 481-6482
(443) 481-6515
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4071751-36
—
MD
01
—
Y945
CAREFIRST PRODUCTS
MD
Enumeration date
01/24/2012
Last updated
05/24/2021
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