Provider Demographics
NPI:1558310490
Name:GREEN SPRING INTERNAL MEDICINE, LLC
Entity Type:Organization
Organization Name:GREEN SPRING INTERNAL MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:R
Authorized Official - Last Name:DAHLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-608-8964
Mailing Address - Street 1:2360 W JOPPA RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-4624
Mailing Address - Country:US
Mailing Address - Phone:410-583-2890
Mailing Address - Fax:410-583-2891
Practice Address - Street 1:2360 W JOPPA RD
Practice Address - Street 2:SUITE 210
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-4624
Practice Address - Country:US
Practice Address - Phone:410-583-2890
Practice Address - Fax:410-583-2891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0054653207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG94478Medicare UPIN
MD1629031828Medicare ID - Type UnspecifiedNPI ENUMERATOR - WEISHAAR