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NPI Code Detail

MEDICARE: MR. AMBULAI JOHNSON III

MEDICARE: MR. AMBULAI JOHNSON III
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1172V00000XCommunity Health Worker

General Provider Information

NPI Number : 1932888765
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. AMBULAI JOHNSON III
Provider Business Mailing Address
First Line : 11721 CIDER PRESS PL
Second Line :
City : GERMANTOWN
State : MD
Zip : 20876-2712
Country : US
Telephone Number : 202-351-1133
Fax Number :
Provider Business Practice Location Address
First Line : 11721 CIDER PRESS PL
Second Line :
City : GERMANTOWN
State : MD
Zip : 20876-2712
Country : US
Telephone Number : 202-351-1133
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2023
Last Update Date : 07/18/2023

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Directions to “ MR. AMBULAI JOHNSON III ” Practice Location

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