# AMBUSH LAB

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** AMBUSH PEDIATRICS AND FAMILY MEDICAL CLINIC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1295671311
- **Legal business name:** AMBUSH PEDIATRICS AND FAMILY MEDICAL CLINIC
- **Authorized official:** JACQUELINE EBONY AMBUSH DNP (OWNER)
- **Authorized official phone:** (410) 707-5947

## Contact information

- **Practice address:** 4367 HOLLINS FERRY RD STE 1C, BALTIMORE, MD 21227-3400
- **Practice address phone:** (410) 707-5947
- **Practice address fax:** (410) 707-5947
- **Mailing address:** 4367 HOLLINS FERRY RD STE 1C, BALTIMORE, MD 21227-3400
- **Mailing address phone:** (410) 707-5947
- **Mailing address fax:** (410) 707-5947

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QA0000X | Adolescent Medicine (Family Medicine) Physician | — | NULL | Yes |
| 207QA0000X | Adolescent Medicine (Family Medicine) Physician | — | — | Yes |

## Other

- **Enumeration date:** 04/29/2026
- **Last updated:** 04/29/2026