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General NPI Number Information
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NPI Number | 1750562898
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Entity Type | Organization
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Legal Business Name | AMBI PHYSICIAN PC
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Dates
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Enumeration Date | 11/16/2007
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Last Update Date | 11/16/2007
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Provider Practice Location Address
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Address Line | 7485 OAKWOOD RD 103
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City | GLEN BURNIE
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State | MD
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Zip | 21061
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Country | US
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Telephone | 410-766-6447
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Fax | 410-766-9780
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Provider Business Mailing Address
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Address Line | PO BOX 1561
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City | ELLICOTT CITY
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State | MD
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Zip | 21041-1561
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Country | US
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Telephone | 410-766-6447
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Fax | 410-766-9780
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KANDASAMY AMBALAVANAR
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Credential | M.D
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Telephone | 410-766-6447
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | D0051596
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License Number State | MD
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