Healthcare Provider Details

I. General information

NPI: 1245199157
Provider Name (Legal Business Name): PRIVYHEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2026
Last Update Date: 02/13/2026
Certification Date: 02/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7918 JONES BRANCH DR FL 4
MC LEAN VA
22102-3319
US

IV. Provider business mailing address

2800 EISENHOWER AVE STE 220-B23
ALEXANDRIA VA
22314-5204
US

V. Phone/Fax

Practice location:
  • Phone: 703-424-9024
  • Fax: 703-214-2955
Mailing address:
  • Phone: 703-424-9024
  • Fax: 703-214-2955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ELDESIA GRANGER
Title or Position: OWNER
Credential: MD
Phone: 703-424-9024