Provider Demographics
NPI:1740235266
Name:DAHLGREN, ANDREW BASLER (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:BASLER
Last Name:DAHLGREN
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1115 BOULDERS PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23225-4067
Mailing Address - Country:US
Mailing Address - Phone:804-560-5595
Mailing Address - Fax:804-560-9029
Practice Address - Street 1:8200 MEADOWBRIDGE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-2331
Practice Address - Country:US
Practice Address - Phone:804-730-2121
Practice Address - Fax:804-730-0563
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2015-02-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301074317207RS0010X
VA0101057080207QS0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104800110Medicaid
VAP00761603OtherRR MEDICARE
MIG68868Medicare UPIN