Individual
AMBALLUR JOHN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4940 EASTERN AVE, BALTIMORE, MD 21224-2735
(410) 955-6353
Mailing address
PO BOX 64382, BALTIMORE, MD 21264-4382
(410) 955-6353
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
D59050
MD
207LC0200X
Critical Care Medicine (Anesthesiology) Physician
D59050
MD
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
D59050
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
400294600
—
MD
Enumeration date
05/31/2006
Last updated
02/22/2013
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