Provider Demographics
NPI:1306034376
Name:DOTRIM, LLC
Entity Type:Organization
Organization Name:DOTRIM, LLC
Other - Org Name:DOCTRIM PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YISA
Authorized Official - Middle Name:OLANREWAU
Authorized Official - Last Name:YUSSUF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-434-3500
Mailing Address - Street 1:831 UNIVERSITY BLVD E
Mailing Address - Street 2:SUITE 23
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20903-2916
Mailing Address - Country:US
Mailing Address - Phone:301-434-3500
Mailing Address - Fax:301-434-5773
Practice Address - Street 1:831 UNIVERSITY BLVD E
Practice Address - Street 2:SUITE 23
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20903-2916
Practice Address - Country:US
Practice Address - Phone:301-434-3500
Practice Address - Fax:301-434-5773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD51083207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD522300800Medicaid
DC026893100Medicaid
MDG69476Medicare UPIN
MDG00049Medicare PIN