Provider Demographics
NPI:1972743755
Name:BAXTER, MARTIN BRUCE (RPH)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:BRUCE
Last Name:BAXTER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 TALBOTT AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-4334
Mailing Address - Country:US
Mailing Address - Phone:301-617-0555
Mailing Address - Fax:
Practice Address - Street 1:316 TALBOTT AVE
Practice Address - Street 2:SUITE A
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-4334
Practice Address - Country:US
Practice Address - Phone:301-617-0555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-06
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPH100000411183500000X
NC14610183500000X
VA0202007452183500000X
MD18090183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist