Provider Demographics
NPI:1740059476
Name:DINKUM PROSPECT LLC
Entity type:Organization
Organization Name:DINKUM PROSPECT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOTUNRAYO
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEGORUSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-432-7017
Mailing Address - Street 1:11112 PROSPECT HILL RD
Mailing Address - Street 2:
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769-9454
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9211 CORPORATE BLVD STE 270
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3856
Practice Address - Country:US
Practice Address - Phone:240-432-7017
Practice Address - Fax:516-518-0088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-21
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty