Organization
AMBI PHYSICIAN PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KANDASAMY AMBALAVANAR M.D (PRESIDENT)
(410) 766-6447
Entity
Organization
Contact information
Practice address
7485 OAKWOOD RD, 103, GLEN BURNIE, MD 21061
(410) 766-6447
(410) 766-9780
Mailing address
PO BOX 1561, ELLICOTT CITY, MD 21041-1561
(410) 766-6447
(410) 766-9780
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
D0051596
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
147400600
—
MD
Enumeration date
11/16/2007
Last updated
11/16/2007
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