Provider Demographics
NPI:1750521894
Name:OGLESBY, ISAIAH VINCENT JR
Entity type:Individual
Prefix:
First Name:ISAIAH
Middle Name:VINCENT
Last Name:OGLESBY
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4116 BREADFRUIT CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-8954
Mailing Address - Country:US
Mailing Address - Phone:919-324-4084
Mailing Address - Fax:
Practice Address - Street 1:4915 WATERS EDGE DR STE 290
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27606-2393
Practice Address - Country:US
Practice Address - Phone:919-324-4084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-03
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies