Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | D0064743 | MD |
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | D0064743 | MD |
NPI | 1821176017 |
---|---|
Provider Name | Bryan T. Ambro |
First Address | Annapolis, MD 21401-3282 |
Second Address | Annapolis, MD 21401-3282 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2006 |
Last Update Date | 15/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
102864 | GEISINGER (01) | MD |
2154511 | MAMSI (01) | MD |
2448951 | UNITED NATIONAL (01) | MD |
313988 | AMERIGROUP (01) | MD |
I09969 | (02) | MD |