Provider Demographics
NPI:1033140108
Name:TRYBUS, ADAM G JR (MD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:G
Last Name:TRYBUS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2950 FAIRWAY DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-4457
Mailing Address - Country:US
Mailing Address - Phone:814-946-8000
Mailing Address - Fax:814-946-8002
Practice Address - Street 1:2950 FAIRWAY DR
Practice Address - Street 2:SUITE 1
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-4457
Practice Address - Country:US
Practice Address - Phone:814-946-8000
Practice Address - Fax:814-946-8002
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039743E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1226942Medicaid
PAE65843Medicare UPIN
PA640263L63Medicare PIN