=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558310490
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GREEN SPRING INTERNAL MEDICINE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/09/2006
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2360 W JOPPA RD SUITE 210
-----------------------------------------------------
City | LUTHERVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21093-4624
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-583-2890
-----------------------------------------------------
Fax | 410-583-2891
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2360 W JOPPA RD SUITE 210
-----------------------------------------------------
City | LUTHERVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21093-4624
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-583-2890
-----------------------------------------------------
Fax | 410-583-2891
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | DR. HOLLY R. DAHLMAN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 410-608-8964
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | D0054653
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------