Individual
ANDREW BASLER DAHLGREN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8200 MEADOWBRIDGE RD, SUITE 200, MECHANICSVILLE, VA 23116-2331
(804) 730-2121
(804) 730-0563
Mailing address
1115 BOULDERS PKWY, SUITE 200, NORTH CHESTERFIELD, VA 23225-4067
(804) 560-5595
(804) 560-9029
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
0101057080
VA
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
0101057080
VA
207RS0010X
Sports Medicine (Internal Medicine) Physician
4301074317
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104800110
—
MI
01
—
P00761603
RR MEDICARE
VA
Enumeration date
05/23/2006
Last updated
02/19/2015
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