1972795367 NPI number — VICTOR R. AYBAR,DPM,PA

Table of content: (NPI 1972795367)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972795367 NPI number — VICTOR R. AYBAR,DPM,PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VICTOR R. AYBAR,DPM,PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972795367
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10706 REISTERSTOWN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OWINGS MILLS
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21117-2720
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2963 MANCHESTER RD STE D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANCHESTER
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21102-1853
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-374-2229
Provider Business Practice Location Address Fax Number:
410-374-2281
Provider Enumeration Date:
08/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
AYBAR
Authorized Official First Name:
VICTOR
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
410-374-2229

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  01134 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 759748701 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 958036 . This is a "AETNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: R2660001 . This is a "BLUECHOICE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: R2660001 . This is a "BC/BS FEDERAL" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 2103244 . This is a "OPTIMUM CHOICE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 52584001 . This is a "BC/BS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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