Provider Demographics
NPI:1528252830
Name:TRYBUCH, ELIEZER (DPM)
Entity type:Individual
Prefix:DR
First Name:ELIEZER
Middle Name:
Last Name:TRYBUCH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14417 SYLVAN GLADE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20878-4816
Mailing Address - Country:US
Mailing Address - Phone:202-543-0035
Mailing Address - Fax:301-251-2138
Practice Address - Street 1:14417 SYLVAN GLADE DRIVE
Practice Address - Street 2:
Practice Address - City:NORTH POTOMSC
Practice Address - State:MD
Practice Address - Zip Code:20878
Practice Address - Country:US
Practice Address - Phone:202-543-0035
Practice Address - Fax:301-251-2138
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-29
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD430213E00000X
DC295213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC011323100Medicaid
DC011323100Medicaid
DC5459450001Medicare NSC
DCT30798Medicare UPIN
DC501943Medicare PIN