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General NPI Number Information
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NPI Number | 1073375416
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Entity Type | Organization
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Legal Business Name | PRIVIA MEDICAL GROUP, LLC
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Dates
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Enumeration Date | 01/30/2024
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Last Update Date | 01/27/2026
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Provider Practice Location Address
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Address Line | 15215 SHADY GROVE RD STE 303
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City | ROCKVILLE
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State | MD
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Zip | 20850-0201
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Country | US
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Telephone | 301-330-3216
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Fax |
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Provider Business Mailing Address
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Address Line | 950 N GLEBE RD STE 700
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City | ARLINGTON
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State | VA
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Zip | 22203-4173
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Country | US
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Telephone | 571-982-6636
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Fax |
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Authorized Official
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Title or Position | AVP
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Name | BRIANNA FOULKROD
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Credential |
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Telephone | 571-650-2710
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number |
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License Number State |
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