Healthcare Provider Details

I. General information

NPI: 1558251512
Provider Name (Legal Business Name): PRIVIA MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2025
Last Update Date: 01/27/2026
Certification Date: 01/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14900 POTOMAC TOWN PL STE 110
WOODBRIDGE VA
22191-4095
US

IV. Provider business mailing address

PO BOX 13050
BELFAST ME
04915-4021
US

V. Phone/Fax

Practice location:
  • Phone: 571-506-0500
  • Fax: 571-506-0525
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: BRIANNA FOULKROD
Title or Position: AVP
Credential:
Phone: 571-650-2710