Provider Demographics
NPI:1558975508
Name:MARGERUM, MARLENE JOAN (NP)
Entity Type:Individual
Prefix:MISS
First Name:MARLENE
Middle Name:JOAN
Last Name:MARGERUM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6052 AUGUSTINE AVE
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-5351
Mailing Address - Country:US
Mailing Address - Phone:443-820-7565
Mailing Address - Fax:
Practice Address - Street 1:6052 AUGUSTINE AVE
Practice Address - Street 2:
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-5351
Practice Address - Country:US
Practice Address - Phone:443-820-7565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-06
Last Update Date:2020-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR158868363LG0600X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology