NPI Code Detail JSON Logo

1295671311 NPI number — AMBUSH LAB

NPI Number: 1295671311
Health Care Provider/Practitioner: AMBUSH LAB

Information about “1295671311” NPI (AMBUSH LAB) exists in 1295671311 in HTML format HTML  |  1295671311 in plain Text format TXT  |  1295671311 in PDF (Portable Document Format) PDF  |  1295671311 in an XML format XML  formats.

NPI Number : 1295671311 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1295671311",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "Y",
    "ParentOrgLBN": "AMBUSH PEDIATRICS AND FAMILY MEDICAL CLINIC",
    "ParentOrgTIN": null,
    "OrgName": "AMBUSH LAB",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "4367 HOLLINS FERRY RD STE 1C",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BALTIMORE",
    "MailingAddressStateName": "MD",
    "MailingAddressPostalCode": "21227-3400",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "410-707-5947",
    "MailingAddressFaxNumber": "410-707-5947",
    "FirstLinePracticeLocationAddress": "4367 HOLLINS FERRY RD STE 1C",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BALTIMORE",
    "PracticeLocationAddressStateName": "MD",
    "PracticeLocationAddressPostalCode": "21227-3400",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "410-707-5947",
    "PracticeLocationAddressFaxNumber": "410-707-5947",
    "EnumerationDate": "04/29/2026",
    "LastUpdateDate": "04/29/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "AMBUSH",
    "AuthorizedOfficialFirstName": "JACQUELINE",
    "AuthorizedOfficialMiddleName": "EBONY",
    "AuthorizedOfficialTitle": "OWNER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "DNP",
    "AuthorizedOfficialTelephoneNumber": "410-707-5947",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "207QA0000X",
        "TaxonomyName": "Adolescent Medicine (Family Medicine) Physician",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
      }
    }
  }
}
                
            

Copyright © 2007-2026 Data Labs Health. All rights reserved.