Organization
AMBUSH PEDIATRICS AND FAMILY MEDICAL CLINIC
Active
Other names
Ambush Pediatrics and Family MedicaL Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACQUELINE EBONY AMBUSH DNP (OWNER/OPERATOR)
(410) 707-5947
Entity
Organization
Contact information
Practice address
4367 HOLLINS FERRY RD STE 1C, HALETHORPE, MD 21227-3400
(410) 609-6677
(410) 609-6672
Mailing address
4367 HOLLINS FERRY RD STE 1C, HALETHORPE, MD 21227-3400
(410) 609-6677
(410) 609-6672
Taxonomy
Speciality
Code
Description
License number
State
207QA0000X
Adolescent Medicine (Family Medicine) Physician
Primary
—
—
261QH0100X
Health Service Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
080454100
—
MD
05
—
999223500
—
MD
Enumeration date
12/02/2020
Last updated
04/29/2026
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