Healthcare Provider Details

I. General information

NPI: 1770055238
Provider Name (Legal Business Name): PRIVIA WOMENS HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2018
Last Update Date: 12/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7611 FOREST AVE STE 200
RICHMOND VA
23229-4946
US

IV. Provider business mailing address

950 N GLEBE RD STE 4000
ARLINGTON VA
22203-1824
US

V. Phone/Fax

Practice location:
  • Phone: 571-366-8850
  • Fax:
Mailing address:
  • Phone: 571-366-8850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: COURTNEY IVESS
Title or Position: ASSOCIATE DIRECTOR, CREDENTIALING
Credential:
Phone: 571-366-8831