Healthcare Provider Details

I. General information

NPI: 1114042496
Provider Name (Legal Business Name): AMY S. BARANOSKI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1427 VINE ST 2ND FLOOR
PHILADELPHIA PA
19102-1031
US

IV. Provider business mailing address

245 N 15TH ST STE 6104
PHILADELPHIA PA
19102-1101
US

V. Phone/Fax

Practice location:
  • Phone: 215-762-7824
  • Fax: 215-762-5257
Mailing address:
  • Phone: 215-255-7822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD427518
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberMD427518
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: