Healthcare Provider Details

I. General information

NPI: 1588476618
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

7906 ANDRUS RD STE 7
ALEXANDRIA VA
22306-3169
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 703-360-8881
  • Fax: 301-868-0026
Mailing address:
  • Phone: 800-973-1442
  • Fax: 571-982-6636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State

VIII. Authorized Official

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