Healthcare Provider Details

I. General information

NPI: 1124986567
Provider Name (Legal Business Name): PRIVIA MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2026
Last Update Date: 01/14/2026
Certification Date: 01/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10750 COLUMBIA PIKE STE 200
SILVER SPRING MD
20901-4454
US

IV. Provider business mailing address

950 N GLEBE RD
ARLINGTON VA
22203-1824
US

V. Phone/Fax

Practice location:
  • Phone: 202-832-1800
  • Fax:
Mailing address:
  • Phone: 800-973-1442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: VIDYA P MOTIRAM
Title or Position: VP, CREDENTIALING & ENROLLMENT
Credential:
Phone: 347-754-1611