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General NPI Number Information
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NPI Number | 1154110351
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Entity Type | Organization
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Legal Business Name | PAUL AMBUSH MD, PA
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Dates
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Enumeration Date | 05/05/2025
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Last Update Date | 05/05/2025
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Provider Practice Location Address
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Address Line | 6100 DAYLONG LN STE 210
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City | CLARKSVILLE
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State | MD
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Zip | 21029-1655
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Country | US
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Telephone | 410-531-7566
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Fax | 410-531-9790
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Provider Business Mailing Address
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Address Line | 6030 DAYBREAK CIR STE A150
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City | CLARKSVILLE
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State | MD
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Zip | 21029-1638
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Country | US
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Telephone | 410-707-5956
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Fax |
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Authorized Official
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Title or Position | OFFICER
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Name | PAUL AMBUSH
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Credential | MD
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Telephone | 410-531-7566
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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