Healthcare Provider Details

I. General information

NPI: 1922810076
Provider Name (Legal Business Name): PRIVIA MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2025
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 IRVING ST NW STE 218
WASHINGTON DC
20010-2993
US

IV. Provider business mailing address

950 N GLEBE RD STE 700
ARLINGTON VA
22203-4173
US

V. Phone/Fax

Practice location:
  • Phone: 202-855-9680
  • Fax: 202-758-3074
Mailing address:
  • Phone: 800-973-1442
  • Fax: 571-982-6636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MARIA GABBAI
Title or Position: DIRECTOR
Credential:
Phone: 610-530-4363