Organization
LUMINIS HEALTH MEDICAL GROUP, LLC
Active
Other names
PAVILION OB/GYN
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PETER ODENWALD (VICE PRESIDENT)
(443) 481-6415
Entity
Organization
Contact information
Practice address
2002 MEDICAL PKWY, SUITE 635, ANNAPOLIS, MD 21401-3046
(410) 224-1133
(410) 266-1639
Mailing address
PO BOX 12622, BELFAST, ME 04915-4017
(443) 481-6524
(443) 481-6515
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
407175101
—
MD
01
—
896BPA
BCBS
—
01
—
K582
BCBS
—
Enumeration date
03/07/2006
Last updated
05/24/2021
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