Healthcare Provider Details

I. General information

NPI: 1306774724
Provider Name (Legal Business Name): SPRINGSIDE HEALTH PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12210 PLUM ORCHARD DR STE 217
SILVER SPRING MD
20904-7911
US

IV. Provider business mailing address

647 RIDGELY AVE STE 140
ANNAPOLIS MD
21401-1069
US

V. Phone/Fax

Practice location:
  • Phone: 410-357-1125
  • Fax: 410-357-1125
Mailing address:
  • Phone: 410-357-1125
  • Fax: 410-357-1125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JODI BOSANKO
Title or Position: OFFICE MANAGER
Credential:
Phone: 410-357-1125