MEDICARE: GREEN SPRING INTERNAL MEDICINE, LLC

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	207R00000X	Internal Medicine Physician	D0054653	MD

General Provider Information

NPI Number	:	1558310490
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREEN SPRING INTERNAL MEDICINE, LLC

Provider Business Mailing Address
First Line	:	2360 W JOPPA RD
Second Line	:	SUITE 210
City	:	LUTHERVILLE
State	:	MD
Zip	:	21093-4624
Country	:	US
Telephone Number	:	410-583-2890
Fax Number	:	410-583-2891

Provider Business Practice Location Address
First Line	:	2360 W JOPPA RD
Second Line	:	SUITE 210
City	:	LUTHERVILLE
State	:	MD
Zip	:	21093-4624
Country	:	US
Telephone Number	:	410-583-2890
Fax Number	:	410-583-2891

Authorized Official
Title or Position	:	MEMBER
Name	:	DR. HOLLY R. DAHLMAN
Credential	:	M.D.
Telephone Number	:	410-608-8964

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	07/21/2022

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