MOTUNRAYO OMOLOYE ADEGORUSI (NPI# 1568941797) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1568941797 |
| Entity Type | Individual |
| Full Name | MOTUNRAYO OMOLOYE ADEGORUSI |
| Practice Address |
7800 House of Corrections Rd Jessup MD 20794 |
| Mailing Address |
11112 Prospect Hill Rd Glenn Dale MD 20769-9454 |
| Practice Telephone | 4107996100 |
| Mailing Telephone | 3018600458 |
| Enumeration Date | 2018-08-08 |
| Last Update Date | 2018-08-08 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP2300X |
Nurse Practitioner Specialization: Primary Care |
R196811 | MD | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MD | CDS | N92802 | 01 |
| MD | DEA | MA4703484 | 01 |
| Street Address |
7800 HOUSE OF CORRECTIONS RD |
| City | JESSUP |
| State | MD |
| Zip Code | 20794 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801399373 | Marnette Valcin | Nurse Practitioner | 7800 House of Corrections Rd, Jessup, MD 20794 | 2018-03-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629508478 | Maryland Cvs Pharmacy L L C | Durable Medical Equipment & Medical Supplies | 7650 Port Capital Drive, Jessup, MD 20794 | 2017-06-14 |
| 1326446980 | Matthew Carpenter | Physician Assistant | 7805 House of Correction Rd., Jessup, MD 20794 | 2014-12-15 |
| 1053753616 | Bollman Bridge Elementary School-based Wellness Center | Clinic/Center | 8200 Savage-guilford Road, Jessup, MD 20794 | 2013-07-24 |
| 1962760199 | Mesfin T Frew | Physician Assistant | 755 Waterloo Road, Jessup, MD 20794 | 2012-04-25 |
| 1730462920 | Grady Foster Jr. | Dentist | 7804 Maryland House of Correction Road, Jessup, MD 20794 | 2011-09-23 |
| 1528211794 | Brian Byung Woo Choi | Dentist | 7800 House of Correction Road, Jessup, MD 20794 | 2008-10-31 |
| 1659315851 | Family Care Pharmacy, Inc. | Durable Medical Equipment & Medical Supplies | 8610 Baltimore Washington Blvd, Suite 110, Jessup, MD 20794 | 2006-06-16 |
| 1104346006 | Charity Allwell | Registered Nurse | 7365 Cedar Ave, Jessup, MD 20794 | 2017-06-21 |
| 1255401154 | Medical Management Specialists, Inc. | Clinic/Center | 8106 D-stayton Drive, Jessup, MD 20794-0934 | 2006-11-08 |
| 1689965246 | Cristen Lee Cardwell | Occupational Therapist | 8310 Autumn Way, Apt 3-d, Jessup, MD 20794-2913 | 2011-04-29 |
| Find all providers in zip 20794 | ||||
| Taxonomy Code | 363LP2300X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Primary Care |
| Definition to come... |
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| 1225653611 | Zynith Health Care & Associates | Nurse Practitioner | 4061 Powder Mill Rd Ste 101, Beltsville, MD 20705-3156 | 2020-06-11 |
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| 1437785706 | Hajia M Nagaiya | Nurse Practitioner | 3525 Courtleigh Dr, Baltimore, MD 21244-2205 | 2020-03-19 |
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| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.