MEDICARE: SPRINGSIDE HEALTH PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1306774724
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPRINGSIDE HEALTH PC

Provider Business Mailing Address
First Line	:	647 RIDGELY AVE STE 140
Second Line	:
City	:	ANNAPOLIS
State	:	MD
Zip	:	21401-1069
Country	:	US
Telephone Number	:	410-357-1125
Fax Number	:	410-357-1125

Provider Business Practice Location Address
First Line	:	12210 PLUM ORCHARD DR STE 217
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20904-7911
Country	:	US
Telephone Number	:	410-357-1125
Fax Number	:	410-357-1125

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	JODI BOSANKO
Credential	:
Telephone Number	:	410-357-1125

Provider Enumeration Date	:	05/13/2026
Last Update Date	:	05/13/2026

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Directions to “SPRINGSIDE HEALTH PC ” Practice Location

Language	Start Address	Practice Location

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