MEDICARE: PRIVIA MEDICAL GROUP, 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	207VG0400X	Gynecology Physician

General Provider Information

NPI Number	:	1336095827
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIVIA MEDICAL GROUP, LLC

Provider Business Mailing Address
First Line	:	950 N GLEBE RD STE 700
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22203-4173
Country	:	US
Telephone Number	:	800-973-1442
Fax Number	:	571-982-6636

Provider Business Practice Location Address
First Line	:	2810 OLD LEE HWY STE 305
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22031-4376
Country	:	US
Telephone Number	:	703-642-7522
Fax Number	:	703-642-7565

Authorized Official
Title or Position	:	ENROLLMENT SPECIALIST
Name	:	REBECCA INOA
Credential	:
Telephone Number	:	843-569-6524

Provider Enumeration Date	:	03/06/2026
Last Update Date	:	03/06/2026

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