| Ambush Pediatrics And Family Medical Clinic | |
|
4367 Hollins Ferry Rd Ste 1c Halethorpe MD 21227-3400 | |
| (410) 609-6677 | |
| (410) 609-6672 |
| Full Name | Ambush Pediatrics And Family Medical Clinic |
|---|---|
| Speciality | Family Medicine - Adolescent Medicine |
| Location | 4367 Hollins Ferry Rd Ste 1c, Halethorpe, Maryland |
| Authorized Official Name and Position | Jacqueline Ebony Ambush (OWNER/OPERATOR) |
| Authorized Official Contact | 4107075947 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ambush Pediatrics And Family Medical Clinic 11610 Clarksville Pike Ellicott City MD 21042-6142 Ph: (410) 609-6677 | Ambush Pediatrics And Family Medical Clinic 4367 Hollins Ferry Rd Ste 1c Halethorpe MD 21227-3400 Ph: (410) 609-6677 |
| NPI Number | 1457956948 |
|---|---|
| Provider Enumeration Date | 12/02/2020 |
| Last Update Date | 12/02/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457956948 | NPI | - | NPPES |
| 080454100 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QA0000X | Family Medicine - Adolescent Medicine | (* (Not Available)) | Primary |
| 261QH0100X | Clinic/center - Health Service | (* (Not Available)) | Secondary |
Priority Care Primary Care Clinics Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 3720 Washington Blvd Ste 100, Halethorpe, MD 21227 Phone: 410-646-0001 |