Healthcare Provider Details

I. General information

NPI: 1548183098
Provider Name (Legal Business Name): ROBERT MARTIN BARANOSKI JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4940 EASTERN AVE
BALTIMORE MD
21224-2735
US

IV. Provider business mailing address

4940 EASTERN AVE
BALTIMORE MD
21224-2735
US

V. Phone/Fax

Practice location:
  • Phone: 410-550-0958
  • Fax:
Mailing address:
  • Phone: 410-550-0958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberT24046
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: