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General NPI Number Information
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NPI Number | 1124986567
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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 | 01/14/2026
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Last Update Date | 01/14/2026
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Provider Practice Location Address
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Address Line | 10750 COLUMBIA PIKE STE 200
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City | SILVER SPRING
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State | MD
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Zip | 20901-4454
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Country | US
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Telephone | 202-832-1800
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Fax |
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Provider Business Mailing Address
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Address Line | 950 N GLEBE RD
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City | ARLINGTON
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State | VA
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Zip | 22203-1824
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Country | US
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Telephone | 800-973-1442
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Fax |
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Authorized Official
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Title or Position | VP, CREDENTIALING & ENROLLMENT
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Name | VIDYA P MOTIRAM
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Credential |
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Telephone | 347-754-1611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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