Paul Franklin Ambush Jr., M.D.
Individual provider Active NPI Pediatrics Physician · Clarksville, MD
NPI 1730105461 · NPPES record last updated Sep 8, 2025
Key facts
- NPI
- 1730105461
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- D0044955 (MD)
- Practice address
- 6100 Daylong LN Ste 210
Clarksville, MD 21029-1655 - Phone
- (410) 531-7566
- Fax
- (410) 531-9790
- NPI assigned
- Jul 14, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MD
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20141013001574 | MD | Order and Referring Only - Pediatric Medicine |
4789572439 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D0044955 | MD | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Paul Ambush MD, PA | Pediatrics | Current |
Accepting new patients |
| Frederick Health Hospital Inc | Past | Accepting new patients | |
| Yardmore Emergency Physicians LLC | Past | Accepting new patients |
Locations
6100 Daylong Ln
Ste 210
Clarksville, MD 21029
Phone (410) 531-7566
6030 Daybreak Cir
Ste A150
Clarksville, MD 21029
Phone (240) 204-1303
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | D0044955 | MD | Yes |
Addresses
Primary practice location
6100 Daylong LN Ste 210
Clarksville, MD 21029-1655
Mailing address
6030 Daybreak Cir Ste A150
Clarksville, MD 21029-1638
Phone (410) 531-7566
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| G777-0001 | Other | MD | BLUECHOICE BC/BS MD |
| 492666 | Other | MD | NCPPO |
| 8101718 | Other | MD | MAMSI |
| KDV5PA | Other | MD | CAREFIRST BC/BS |
| 2101718 | Other | MD | ALLIANCE |
| 8101718 | Other | MD | MDIPA |
| 1203054 | Other | MD | UNITED HEATH CARE |
| 21394 | Other | MD | PRIORITY PARTNERS |
| 04134000000 | Other | MD | PHN |
| 152231100 | Medicaid | MD | |
| 1808419 | Other | MD | UNITED HEALTH CARE |
| 5916668 | Other | MD | AETNA, NON-HMO |
| 2108817 | Other | MD | AETNA, HMO |
| 21394 | Other | MD | EHP, JOHNS HOPKINS |
| 8101718 | Other | MD | OPTIMUM CHOICE |
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All providers in Clarksville, MD · Pediatrics Physician in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 8, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.