Healthcare Provider Details

I. General information

NPI: 1396680930
Provider Name (Legal Business Name): MARCUS OGLESBY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7711 QUARTERFIELD RD STE A
GLEN BURNIE MD
21061-4492
US

IV. Provider business mailing address

7711 QUARTERFIELD RD STE A
GLEN BURNIE MD
21061-4492
US

V. Phone/Fax

Practice location:
  • Phone: 410-761-5600
  • Fax:
Mailing address:
  • Phone: 410-761-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR277823
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: