Provider Demographics
NPI:1972795367
Name:VICTOR R. AYBAR,DPM,PA
Entity Type:Organization
Organization Name:VICTOR R. AYBAR,DPM,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:R
Authorized Official - Last Name:AYBAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-374-2229
Mailing Address - Street 1:10706 REISTERSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-2720
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2963 MANCHESTER RD STE D
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:MD
Practice Address - Zip Code:21102-1853
Practice Address - Country:US
Practice Address - Phone:410-374-2229
Practice Address - Fax:410-374-2281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-09
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01134213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD759748701Medicaid
MD958036OtherAETNA
MDR2660001OtherBLUECHOICE
MDR2660001OtherBC/BS FEDERAL
MD2103244OtherOPTIMUM CHOICE
MD52584001OtherBC/BS
MD52584001OtherBC/BS
MDT347Medicare PIN