Organization
LUMINIS HEALTH MEDICAL GROUP, LLC
Active
Other names
Waugh Chapel Family Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PETER ODENWALD (VP)
(443) 481-6415
Entity
Organization
Contact information
Practice address
2401 BRANDERMILL BLVD, SUITE 250, GAMBRILLS, MD 21054-1690
(410) 721-1507
(410) 721-1510
Mailing address
PO BOX 12622, BELFAST, ME 04915-4017
(443) 481-6576
(443) 481-6515
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
407175106
—
MD
01
—
956BWA
BCBS
—
01
—
K644
BCBS
—
Enumeration date
03/07/2006
Last updated
05/24/2021
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