Ambi Physician Pc | |
7485 Oakwood Rd 103 Glen Burnie MD 21061 | |
(410) 766-6447 | |
(410) 766-9780 |
Full Name | Ambi Physician Pc |
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Speciality | Clinic/Center |
Location | 7485 Oakwood Rd, Glen Burnie, Maryland |
Authorized Official Name and Position | Kandasamy Ambalavanar (PRESIDENT) |
Authorized Official Contact | 4107666447 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Ambi Physician Pc Po Box 1561 Ellicott City MD 21041-1561 Ph: (410) 766-6447 | Ambi Physician Pc 7485 Oakwood Rd 103 Glen Burnie MD 21061 Ph: (410) 766-6447 |
NPI Number | 1750562898 |
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Provider Enumeration Date | 11/16/2007 |
Last Update Date | 11/16/2007 |
Medicare PECOS PAC ID | 2163412255 |
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Medicare Enrollment ID | O20040512000873 |
Identifier | Type | State | Issuer |
---|---|---|---|
1750562898 | NPI | - | NPPES |
147400600 | Medicaid | MD |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | D0051596 (Maryland) | Primary |
Provider Name | Kandasamy Ambalavanar |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1477647097 PECOS PAC ID: 2668507054 Enrollment ID: I20100324000716 |
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