Provider Demographics
NPI:1942192810
Name:LUX MEDICA LLC
Entity type:Organization
Organization Name:LUX MEDICA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED PHYSICIAN ASSISTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:CLIFTON
Authorized Official - Last Name:MCCORMICK
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:443-454-1761
Mailing Address - Street 1:314 CEDAR LN
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21403-3909
Mailing Address - Country:US
Mailing Address - Phone:443-454-1761
Mailing Address - Fax:712-208-8175
Practice Address - Street 1:1447 YORK RD STE 406
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-6057
Practice Address - Country:US
Practice Address - Phone:410-343-3001
Practice Address - Fax:410-823-0015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-16
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty