Healthcare Provider Details

I. General information

NPI: 1568305571
Provider Name (Legal Business Name): PRIVIA MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3510 WORTHINGTON BLVD UNIT 101
FREDERICK MD
21704-7066
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 240-813-4199
  • Fax:
Mailing address:
  • Phone: 800-973-1442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: BRIANNA FOULKROD
Title or Position: VP, CRED & ENROLLMENT
Credential:
Phone: 571-650-2710