| Ambush Lab | |
|
4367 Hollins Ferry Rd Ste 1c Baltimore MD 21227-3400 | |
| (410) 707-5947 | |
| (410) 707-5947 |
| Full Name | Ambush Lab |
|---|---|
| Speciality | Family Medicine - Adolescent Medicine |
| Location | 4367 Hollins Ferry Rd Ste 1c, Baltimore, Maryland |
| Authorized Official Name and Position | Jacqueline Ebony Ambush (OWNER) |
| Authorized Official Contact | 4107075947 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ambush Lab 4367 Hollins Ferry Rd Ste 1c Baltimore MD 21227-3400 Ph: (410) 707-5947 | Ambush Lab 4367 Hollins Ferry Rd Ste 1c Baltimore MD 21227-3400 Ph: (410) 707-5947 |
| NPI Number | 1295671311 |
|---|---|
| Provider Enumeration Date | 04/29/2026 |
| Last Update Date | 04/29/2026 |
| Certification Date | 04/29/2026 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295671311 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QA0000X | Family Medicine - Adolescent Medicine | () | Primary |
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